Clock ticking on Michigan Medicaid expansion

State faces Oct. deadline to begin enrollment

Jul. 6, 2013 11:22 PM  

In the battle over a proposed Medicaid expansion, tempers are flaring, the rhetoric is flying, and those on both sides have pounded their war drums in a bid to press the issue.

Amid all the drama, the future of the expansion — the shape it will take, whether it occurs at all — now rests with a bipartisan workgroup of eight state senators who begin meeting this week to review the proposal to provide health insurance to 320,000 low-income Michigan residents.

As of now, Michigan almost certainly will not be able to enroll these people in a Medicaid expansion beginning Oct. 1, which prepares for the program’s start Jan. 1. That’s because the state House already has passed their own version of a Medicaid expansion that needs a 90-day federal review process, and Senate Republicans want to develop their own version of an expanded Medicaid.

That means even if the Legislature agreed this week on a reform version of Medicaid, Michigan would be two weeks behind in enrolling participants once the federal review is over in mid-October.

“The Republicans, by their inaction, are putting Michigan behind an eight ball,” said Senate Minority Leader Gretchen Whitmer, an East Lansing Democrat who backs the expansion.

Many things must happen for any sort of Medicaid expansion to begin in Michigan by early next year.

The Senate workgroup must recommend its own plan for reforming Medicaid in coming weeks, the Republican-controlled Senate must approve it, and the Republican-controlled House, which already has approved its own plan, must then sign off on the Senate version. All this must somehow occur when the Legislature is mostly on summer break through the end of August, and renovations in both chambers could hinder a special session from being called.

Once those hoops are jumped, the plan then needs the blessing of Uncle Sam.

If successful, it would be an impressive feat of legislative acrobatics worthy of Ringling Bros. circus. But Whitmer said she is at least hopeful that real progress can be made in the next few weeks.

Meanwhile, Senate Majority Leader Randy Richardville, who created the workgroup, said he is sincere at allowing the Senate to iron out a Medicaid expansion proposal acceptable to the super-majority of Republicans in the chamber. He insists he saved Gov. Rick Snyder, who backs the expansion, from a major defeat last month by refusing to call a vote on Medicaid, saying the needed Republican votes simply weren’t there to pass it.

Snyder saw it differently and returned from a business trip to Israel to chastise Richardville and Senate Republicans, imploring them to “take a vote, not a vacation.”

“This debate, this issue, is alive because I provided leadership on this issue based on the feedback from the Senate Republican caucus,” Richardville said. “This thing was dead if we had taken a vote when it was being demanded.

While Richardville is correct that the issue is not yet dead, it remains unclear how strong a pulse it has. Richardville said the workgroup of six Republican senators and two Democratic senators were selected to represent a wide range of views on Medicaid.

One of the Republicans, Sen. Bruce Caswell of Hillsdale, already has proposed replacing the expansion with a plan to provide catastrophic care to low-income state residents through the private health market, and many Republicans are nervously facing tough challenges from the tea party if they back any version of an expansion.

Whitmer worries a new Senate plan will hit the pocketbooks of Medicaid participants even harder than the House version.

“If it does, it may lose support on the Democratic side of the aisle,” she said. “We can’t totally capitulate to the tea party.”

In recent days, Snyder has toned down his criticism of the Senate, but has continued to stump for a Medicaid expansion in a tour around the state. He also has defended billboards that call on at least 10 GOP senators by name to support the expansion.

Snyder has pushed for an expansion since February, saying it would be a key pillar of maintaining vital health services.

Under the Affordable Care Act, the federal government would pay the full cost of the expansion for the first three years — injecting about $2 billion annually into the state — and, after that, it ultimately would pay 90 percent of the costs. The state’s share then would be about $200 million annually, partly or fully offset by savings in other areas.

After months of delay, proponents considered it a major victory last month when the state House passed their own version of a Medicaid expansion, a proposal needing federal approval that would require most low-income participants to pay part of their health care through copays. Despite urgency cited by Snyder and others, however, Richardville refused to call a vote on it.

Rich Studley, president and CEO of the Michigan Chamber of Commerce — among the business groups that are backing a Medicaid expansion — said he is encouraged the Senate is at least studying the House plan for possible changes, rather than voting down the House plan and starting from scratch. Starting over, he said, would have given the Legislature little hope of meeting the deadline.

The chamber and the Small Business Association of Michigan support a Medicaid expansion partly because next year the federal government will begin to drastically reduce its funding to hospitals for uncompensated care. Without an expansion, the groups believe businesses will face higher premiums as low-income people continue to go without preventive care and seek emergency care in hospitals.

“Senators felt they were rushed (two weeks ago), and they now have time to study the issue,” Studley said. “We’re going to get this done in a way that will pass.”

Studley said he also is encouraged the Obama administration last week agreed to delay implementing mandates for businesses to provide health insurance to their employees. He said this suggests that if Michigan misses the Oct. 1 deadline to begin enrolling Medicaid participants, there may be some flexibility.

Richardville said the Senate workgroup, which reports to the Senate Government Operations Committee, will meet twice weekly to hammer out a new plan for Medicaid. He said the committee, which he chairs, will reconvene next week to assess the workgroup’s progress.

What’s next

» The Healthy Michigan Workgroup, a group of six Republican and two Democratic state senators, will begin meeting this week to form a plan to reform and expand Medicaid that it can recommend to the Senate. Senate Majority Leader Randy Richardville formed the group after refusing to call a vote on a Medicaid expansion last month, saying there were not enough votes to pass it. The Senate and House would have to approve any final plan and — if Gov. Rick Snyder signs off on it — it then goes to federal officials for a lengthy review process.
» With a Medicaid expansion, proponents hope to provide government-funded health insurance to 320,000 low-income individuals in Michigan who are not covered under the current federal program. The program, which would begin Jan. 1, would be fully federally funded for first three years; eventually 10 percent of the cost would be shifted to Michigan.