Medicaid Expansion Battle in Michigan Ends in Passage
Published: August 27, 2013 - New York Times
CHICAGO — The fierce struggle among Republicans over
whether to make Medicaid
available to more low-income people played out in Michigan on Tuesday as the
Republican governor, Rick Snyder, narrowly succeeded in swaying enough
conservative senators in the State Legislature to accept the expansion, which
was part of President
Obama’s health
care law.
Mr. Snyder’s preferred bill — one he had lobbied for
intensely for months — initially fell short by one vote, but the governor
salvaged a deal hours later. The vote in the Republican-controlled Senate was 20
to 18, with only 8 Republicans in favor. The Michigan House, which had earlier
approved a similar measure, will need to vote on the Senate version before Mr.
Snyder can sign the bill.
“The Affordable Care Act has probably been one of the
most divisive issues that our country has faced in the last few years, and many
people do have strong opinions both for and against,” Mr. Snyder said after the
vote. “I just ask that all Michiganders step back and look to say this isn’t
about the Affordable Care Act. This is about one element that we control here in
Michigan that we can make a difference in here in people’s lives.”
While the authors of the federal health care law
intended to expand Medicaid, the federal and state health program for poor
people, and at least initially pay for the expansion, the Supreme Court ruled in
2012 that states could opt out, setting up a struggle that has played out in the
states largely along partisan lines.
Like Mr. Snyder, some Republican governors have found
themselves at odds with their own party’s legislative caucuses in state capitals
like Lansing that are dominated by Republicans.
In Arizona, which eventually approved an expansion,
Gov. Jan Brewer found vehement opposition from some lawmakers. In Florida,
legislators have resisted expansion, despite Gov. Rick Scott’s support. And in
Ohio, Gov. John R. Kasich’s push for expansion has so far not been successful.
For months, the fight in Michigan, which has the
nation’s 10-largest uninsured population, has been intense. Mr. Snyder, a former
businessman in his first term, said the expansion would ultimately save money,
control medical costs and help the state’s economy. That pitted him against more
conservative members of his own party, and led some Tea
Party leaders in the state to say he will lose support if he seeks
re-election next year.
On the floor of the Michigan Senate on Tuesday, the
debate was heated, though lawmakers said the discussions — particularly those
within the Republican caucus — had been even more tense behind closed doors.
Advocates praised the measure as fiscally sensible for
the state, given the promise of federal money, and crucial for hundreds of
thousands of low-income residents without insurance.
Already, Medicaid covers more than 1.8 million people
in the state, Michigan officials said, and the expansion would ultimately grant
coverage to more than 400,000 others. People making up to 133 percent of the
federal poverty level — or about $15,500 a year for a single person — would
newly be covered.
“It’s a benefit to every person in the state of
Michigan,” said State Senator Gretchen Whitmer, the Democratic leader, said on
the floor. “It’s good public policy, and it makes good fiscal sense.”
Senator Roger Kahn, a Republican, told his colleagues,
“This is not Obamacare or the Affordable Care Act.” Instead, he argued, the
measure will reform the costs of medicine across the state and become what he
described as “a national model” for other states.
But opponents said a Medicaid expansion would
represent tacit approval of Mr. Obama’s health care law. They said it would
encourage big government and be an irresponsible promise of spending by Michigan
in the years ahead. Senator Mike Green, a Republican, described the plan as a
promise of “federal funny money.”
And Senator Patrick J. Colbeck, another Republican
opponent, said, “We’re spending money we do not have,” adding, “And we’re
forcing decisions right now onto our youth.”
In June, the Michigan House approved the Medicaid
expansion with support from Democrats and enough members from that chamber’s
Republican majority. But the State Senate, where Republicans hold 26 of 38
seats, moved more slowly, with some conservative Republicans openly rejecting
Mr. Snyder’s views, refusing to call a vote and proposing alternatives.
At one point, Mr. Snyder, who regularly promotes a
gentle-sounding political philosophy of “relentless positive action,” flew home
early from a trade mission to Israel and had uncharacteristically sharp words
for the Senate, telling them to “take a vote, not a vacation.”
In recent days, the struggle intensified. The
governor’s office took part in urgent, private conversations, lawmakers said,
while advocates for and against the measure led demonstrations, ad campaigns and
phone banks around Michigan.
“We firmly believe that a vote to support Medicaid
expansion is a vote to support the president’s health care law,” said one
opponent, Annie Patnaude, deputy state director of Americans for
Prosperity-Michigan. Protesters on the other side of the issue appeared in
Lansing on Tuesday, saying it was high time for a vote.