House Republicans who voted for the Medicaid expansion bill may have put themselves on the hook to cast "yes" votes for spending bills associated with the measure in the future.

When House Bill 4714 was passed by the House, 28 Republicans voted "yes." But in doing so, they could have tied their hands regarding appropriation bills to follow.

Medicaid expansion is the key issue state lawmakers now face regarding the Patient Protection and Affordable Care Act, known as Obamacare. Getting states to do the expansion is an important to step toward implementing Obamacare. However, the U.S. Supreme Court ruled that states don't have to make the expansion.

"(Attorney General) Bill Schuette has consistently opposed the expansion of Medicaid," said Joy Yearout, a spokesperson for Attorney General Schuette. "He believes that the federal government is not a reliable or steady funder and the long term fiscal costs of government expansion of health care is not sustainable and will result in huge costs to Michigan taxpayers."

The Obama administration is offering billions of up-front federal dollars to states that agree to the Medicaid expansion. In the past, taking federal dollars short-term has often led to states spending even greater amounts down the road. This pattern has played a major role in making state budgets swell.

After the House passed House Bill 4714 on June 13, it stalled in the Senate. Gov. Rick Snyder wants the expansion and is trying to pressure the Senate into passing it. He has been promoting the key Obamacare expansion as "Healthy Michigan" instead of calling it Medicaid expansion.

"Attorney General Bill Schuette has been a consistent advocate for important health care reforms, including raising the age of dependency coverage from 21 to 26 years of age and permitting the portability of health care insurance across state lines," Yearout said. "Schuette also strongly supports private sector choices for health insurance instead of one-size-fits-all government mandates." 

If the Medicaid expansion bill is enacted, additional legislative votes will be required to appropriate the federal dollars that are linked to the measure. That means adding $1.5 billion to the state budget this fiscal year and $2.6 billion a few months before the 2014 election. For those looking further down the road, the appropriation figures would go up to $3.07 billion in the third year, according to a Senate Fiscal Agency analysis.

The Republicans who voted for Medicaid expansion but say they oppose Obamacare may have locked themselves into automatically supporting future Medicaid spending bills. From a political perspective, how could they explain opposing any spending measures required to pay for an expansion they supported?

"You would think that anybody who voted for Medicaid expansion, which was a tough vote to make, would know they'd be expected to vote for whatever is required to pay for it," said Inside Michigan Politics Editor Bill Ballenger. "It would be pretty irresponsible to turn around and oppose the appropriations. If they voted for it, I don't see how they just decide not to follow through."