Time to celebrate – Medicaid expansion has PASSED in the Michigan
Senate!
The bill then went to the Michigan Senate for a vote, but
with an insufficient number of the majority party (Republican) agreeing to take
a vote, Majority Leader, Senator Randy Richardville (R-Monroe) decided to
postpone the vote until after the summer break. He assigned a group of six
Republican senators to study and amend the bill over the summer, so the Senate
would have a refined piece of legislation to vote on upon their return in
August. Governor Snyder (Republican) was upset by the fact the Senate had
refused to take a vote, and he spent his summer traveling across the state to
increase support for the expansion, also requesting that voters contact their
senators and ask them to, “Take a vote, not a vacation.” While the senators met
periodically throughout the summer, a vote was never taken during the break;
however, when the senate returned to start a new session on August 27, 2013, it
was a high priority agenda item.
While the senators assigned to the bill over the summer made
some minor adjustments, HB 4714 remained basically intact. There were, however,
two other bills that were designed by Republican senators, Patrick Colbeck and
Bruce Caswell, which were allowed to be presented as well. Both reforms
essentially scratched the Medicaid plan altogether, and both were rejected by
the senate.
After many hours of debates, votes on other bills, and
recesses, the time for the much anticipated vote on HB 4714 finally arrived.
The vote resulted in a 19-18 vote, with Senator Patrick Colbeck abstaining from
the vote. Despite the majority in behalf of the expansion, a bill cannot pass
without a minimum of 20 votes in support. Had Senator Colbeck cast his vote
very likely ‘no’ vote, there would have been a 19-19 tie, and Lt. Governor
Brian Calley would have been ready to cast the tie-breaking vote in support of
the expansion.
Just when it looked as though all hope was lost for the
expansion, a surprising turn of events led to a vote to reconsider the bill
immediately. An amendment was added that stated that hospitals will not be
allowed to charge Medicaid patients more than 115% of what they charge Medicare
patients. With this amendment, a new vote was taken around 8 p.m., and the vote
ended in a 20-18 vote in support of the expansion, after Senator Tom Casperson
(R- Escanaba) switched his initial ‘no’ vote to a ‘yes.’
Despite the bill passing, there is a required two-thirds
majority for a bill to go into immediate effect. Because there was only a
simple majority, the expansion cannot take effect until at least April 1, 2014,
or an Immediate Effect (IE) vote is approved by the Senate. Unfortunately the
delay will cost the state approximately $7 million dollars from the federal
government for every day it is not implemented, but Medicaid expansion will be
moving forward.
While the bill has passed in the Michigan Senate, it must
now return to the Michigan House of Representatives for another vote, due to
the minor amendments added to their original bill, and then passed onto the
federal government for the final approval.
What does this mean
for the State?
Currently, most of those covered by Medicaid are children
and those with incomes less than half of the poverty line. This leaves many
citizens unable to afford private health coverage, and unable to qualify for
Medicaid. With the passage of the bill, citizens earning up to 133% of the Federal
Poverty Line (FPL), or approximately $15,282 for an individual and $31,322 for
a family of four, will become eligible for Medicaid once the bill goes into
effect. In the next few years, it is expected that approximately 470,000
additional Michiganders will be eligible for insurance under this reform. The
expansion, or “Healthy Michigan,” as it is referred to by Governor Snyder, will
be paid for in full by the federal government until 2017. This contribution
will gradually decline until it hits 90% in 2020, where it will remain.
Individuals covered by Medicaid will be helping to fill the
gap as the amount contributed by the federal government declines. As part of
the bill, newly covered individuals will be required to contribute 5% of their
medical costs. This number will increase to 7% after 48-months, unless deemed
otherwise on a case-by-case basis.
With the expansion underway, it is expected that the number
of emergency room visits will decrease and will no longer be a very expensive
alternative for primary care of routine visits. This should also lead to better
health benefits of these individuals, as they will be able to see a regular
health care provider who will get to know their circumstances, and health
history, to provide the best care.
