Commentary: Medicaid expansion

Feb 7, 2013

Governor Rick Snyder  yesterday cast a vote for common sense and pragmatism, by coming out in favor of  expanding Medicaid to what will, within a decade, include almost half a million  people.

Putting purely human considerations aside, the deal makes  enormous economic sense for Michigan. The federal government will pick up all  the costs of the Medicaid expansion for the first three years.  After that,  Michigan has to kick in a tiny amount which will never exceed ten percent. But  from day one, the feds will cover a lot of expenses Michigan pays for today.

The  governor’s staff says this will amount to $206 million dollars next year alone. His budget would prudently stick half those savings in a special  fund to save for the day when Michigan does have to pick up a tiny share of the  expanded Medicaid costs.

Those whose primary focus is caring about  people were, of course, ecstatic. Gilda Jacobs, head of the Michigan League for  Public Policy, said “this is absolutely great news for the four to six hundred  thousand low-income people without health insurance who would now qualify for  Medicaid.”

Jacobs, however, is not just compassionate. She spent eight  years in the state senate, and had to worry about balancing budgets. She also noted that this will save all of us lots of money, including those who have  excellent health insurance.

She noted that investing in preventive care  “reduces unnecessary and expensive emergency room treatment for sick or injured  people who have no other options. There’s no question this will result in a  healthier Michigan with a healthier workforce.”

Well, of course that’s  true. Hospitals and health care systems do pass on the costs of treating the  indigent to the rest of us. If anyone thinks the uninsured don’t use emergency  rooms as a highly expensive free clinic, they haven’t been in a big-city  hospital lately.

But getting this passed isn’t a sure thing. There’s a  joke going around that the right-wing ideologues in the legislature‘s standard  response to any proposal is, “well, it may work in the real world, but does it  hold up in theory?”

Karla Swift, head of the state AFL-CIO, said  something significant yesterday. She supported what the governor proposed, but  added: “It remains to be seen if he will stand up to extremists in his own party  and will fight for what is right on this issue.”

Well, bingo.  The chair of the  senate subcommittee which will first consider the bill is believed to be against  any Medicaid expansion. Other influential legislators are against it. 

Speaker of the House Jase Bolger said he was “cautious and concerned,”  and didn’t exactly rush to his governor’s support.

This issue is going  to force both Republicans and Democrats to make some difficult choices. A year  ago, Snyder might have gotten this passed with a minority of his own party and  near-unanimous support from Democrats. But after right-to-work was jammed down  their throats, some Democrats aren’t willing to make the governor look good on  anything. In the Senate, Democrats are so weak Snyder needs significant GOP  support in any event.

What happens to Medicaid in the legislature may  determine  both the future health of our state, and the governor’s  political career.

Jack Lessenberry is Michigan Radio’s political analyst. Views expressed in the essays by Lessenberry are his own and do not necessarily reflect those of Michigan Radio, its management or the station licensee, The University of Michigan.

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