Medicaid Expansion Plan: New Exterior, Same Core

A Senate work group has come up with the latest version of House Bill 4714, the legislation to expand Medicaid in Michigan.

But despite the redrafting, the heart of the plan remains intact. It would accommodate the implementation of Obamacare.

Gov. Rick Snyder wants the expansion and the hundreds of millions of up front dollars the administration of President Barack Obama has promised in exchange for passage. Refusing to expand Medicaid would put Michigan among 20-plus states that are trying to hold out against it.

On Wednesday, the three bills were moved out of the Senate Government Operations Committee, which followed a June vote by the House to pass Medicaid expansion. Twenty-eight House Republicans voted to pass the expansion, but the Senate didn't take up the bill immediately and created a work group to study options instead.

The three bills that were moved out of committee cover the spectrum including the HB 4714, which would expand Medicaid, and a package of bills that look at free market alternatives to health care coverage.

As it was with the House version of House Bill 4714, the Senate version includes several "reforms." Some of the "reforms" would be subject to ongoing approval by the Obama administration.

Sen. Patrick Colbeck, R-Canton, has introduced his own free market Medicaid measure, which would have reforms without expansion. He said that aspects of the Senate work group bill seem to go along the lines of "government knows best."

"I think it's more about control than it is about care," Sen. Colbeck said. "Part of it includes advantages for healthy behavior. That's a pretty paternal approach."

The work group's legislation has some ideas with merit, but the central issue is still whether it is a good idea to do the expansion, said Sen. John Moolenaar, R-Midland.

"I think they put a lot of time and energy into this," Sen. Moolenaar said. "They did make some improvements to what the House did. There are some market-based aspects. But, at the end of the day, this is a federal program and the federal government will decide what kind of waiver Michigan would get.

"I'm still of the opinion that this does not have long-term sustainability," Sen. Moolenaar continued. "Almost every day we're hearing about the problems that the Affordable Care Act (Obamacare) is running into nationally. I believe we should keep our powder dry and wait until there's a sustainable solution."

Sen. Moolenaar said that federal waivers are not permanent.

"These waivers only last a couple years, so even the waivers we get would be subject to change," he said. "This legislation says something about being able to opt out later, but I think most people know that isn't realistic."

Jack McHugh, senior legislative analyst with Mackinac Center for Public Policy, said the bill the Senate work group drafted is just a rearrangement of the cover story Republican supporters of Medicaid expansion have used for months.

"Like the House passed bill, the 'reforms' in this one are primarily a cover story for Republicans delivering for a hospital cartel that stands to gain billions of dollars if the expansion is approved," McHugh said. "But in the process they're propping up Obamacare just when its vulnerability to a major course correction is becoming ever more apparent, and that's a violation of everything these GOP lawmakers say they stand for."

The Senate work group was formed by Senate Majority Leader Randy Richardville, R-Monroe. Sen. Richardville refused to bring the House version of House Bill 4714 up for a vote in June because a majority of Senate Republicans opposed it. He wasn't willing to have the measure passed by combining a minority of Senate Republicans with Senate Democrats.

Some Lansing insiders think that active resistance to Medicaid expansion by the conservative base might have decreased over the past few weeks.

MIRS newsletter, a political insider publication in Lansing, reported that, in June "...the Senate was under heavy pressure by the Tea Party segment of the state to not vote." The following paragraph continued with, "The belief is that, if time and more information has cooled off some of the white hot anger from June, it could save a Republican incumbent a primary or two in 2014."

More than a few House Republican rank-and-file members were unhappy about the circumstances under which HB 4714 was moved. First, House Speaker Jase Bolger, R-Marshall, brought the bill up for a vote, even though the bill did not have the support of a majority of his caucus. Second, the Senate then responded by not taking a vote on the bill.

On measures such as the Obamacare-linked Medicaid expansion, legislative leaders typically protect their members by limiting the number of times they have to cast votes on such issues. But, when the Senate refused to take up the House version of House Bill 4714, it meant that at least one more vote would need to be taken on Medicaid expansion in the House.

How many of the 28 House Republicans who voted for Medicaid expansion the first time would be willing to do it a second time is an open question. The bill could pass the House again with as few as six Republican "yes" votes going along with 50 Democrats. But Speaker Bolger may not be willing to go that far and some of the House Republicans who oppose the legislation might decide that it's time to fight against it. If so, the battle could take place behind caucus room doors and possibly include floor amendments designed to derail the bill.

It's significant that the Senate changed House Bill 4714 instead of doing its own Senate Bill. With House Bill 4714, if obstacles arise in the House, the option would be open to send the bill to a conference committee. That would provide a means of keeping the legislation alive if it were to become stalled in the House.