Medicaid Expansion Bill Heads to the House

Rep. Mike Shirkey said a little less than two months ago he was a hard "no" vote on the expansion of Medicaid in Michigan.

On Wednesday, the GOP State Representative from Clarklake voted in favor of sending a bill that would allow Medicaid expansion to the House floor for a vote.

The House Michigan Competitiveness Committee voted 9-5 to send House Bill 4714 to the House of Representatives for a vote.

Rep. Shirkey, chair of the competitiveness committee, and fellow GOP State Reps. Frank Foster, R-Petoskey; Dave Pagel, R-Berrien Springs; and Ken Yonker, R-Caledonia, all voted "yes" along with five Democrats.

Reps. Kevin Cotter, R-Mount Pleasant; Ken Goike, R-Ray Township; Ray Franz, R-Onekama; Tom Leonard, R-DeWitt Township; and Dan Lauwers, R-Brockway Township, voted "no" to moving the bill to the House for a vote.

Rep. Gail Haines, R-Waterford, was absent.

Rep. Shirkey said once he researched Medicaid expansion, there were several points that he said made him think it was in the best interests of taxpayers to push for it, although he said he is against Obamacare.

"I hate these rules," Rep. Shirkey said. "I hate Obamacare. I hope at the end of the day, Obamacare is a miserable failure. But it is the law of the land. We got this hand dealt to us."

He said he thinks what eventually will defeat Obamacare is when people realize how truly expensive it will be.

He said Medicaid expansion addressed uncompensated care in the health industry and that estimates of the costs of uncompensated care in Michigan vary from half a billion to a billion dollars year.  

"This provides us an opportunity to address that," Rep. Shirkey said.

Small- and medium-sized businesses in Michigan would be subject to "extreme uncertainty" if Medicaid expansion wasn't an option, he said.

Employees who make between $8 to $10 an hour could go on Medicaid as opposed to signing up for the government health exchanges to get their insurance, Rep. Shirkey said. If the entire population that was from 100 percent to 133 percent of the poverty level went on the government health exchange, taxpayers would pay more in subsidies than they would in taxes if that same group went on the expanded Medicaid, he said.

Critics of Medicaid expansion say they don't trust the federal government to live up to its promise to pay 100 percent of costs even for a few years. And they complain that expanding Medicaid as part of Obamacare will further increase health care costs and further entrench the federal government in people's lives, among other issues.

An Oregon study published in the New England Journal of Medicine showed that expanding Medicaid found that there were few positive effects from Medicaid coverage. 

In an email, Rep. Franz said he was worried the expansion could cover as many as 600,000 additional people.

"What happens to our health care system with the influx of 600,000-plus new covered individuals? It can only be overwhelmed," Rep. Franz said. "While the bill states that it will stop benefits if the Feds don't pay 100 percent … I don't believe for a moment that the benefit could be stopped and I don't believe for a moment that the Feds will pay 100 percent forever. There simply isn't the money for it. 

"I believe it will cost our state more than half a billion dollars a year," he continued. "Where is that revenue going to come from — schools, roads or new taxes? While it would be an easy vote and be a very politically advantageous position, I will not leave that bill to my successors in this seat or to future generations. … This legislation will hurt and entrap people over the long haul; hurt our doctors and health system; cost millions and billions we don't have, and leave future generations with bills and responsibilities that will be difficult if not impossible to handle."

Wednesday's vote to move the bill to the House floor followed a vote on Tuesday that accepted substitute language for HB 4714. The new version of the bill, stripped out items that made passage conditional upon the federal government agreeing to specific terms.