Just get it done on Medicaid expansion

On Feb. 6, Gov. Rick Snyder announced his support for expanding Medicaid as envisioned in the Affordable Care Act. In his announcement, he talked about how the expansion would help hundreds of thousands of people in Michigan (our own estimates at the Center for Healthcare Research & Transformation put the numbers at approximately 290,000 in 2014 and 620,00 by 2020). He called the current way many Michiganders get health care — through the emergency room once they are already sick — as a “dumb way of doing business.” And, he described the Medicaid expansion in terms that business leaders can relate to. He said:

It's all about saving money by being smarter.

When uninsured people go to the emergency room for non-emergency care, instead of seeing a primary care doctor, it costs hospitals millions each year in uncompensated costs. By expanding Medicaid, people will have access to primary care doctors, saving Michigan hospitals those uncompensated care costs.

Job creators, too, will see savings with this law. Under the federal Affordable Care Act, they're required to either provide health care for their employees or pay a significant penalty. Many businesses have said they can't afford the costs — that they'll have to shut their doors. By expanding Medicaid, we can provide an affordable option that will help businesses stay open while offering employees affordable health care.

Remarkably, expanding Medicaid is one public policy that business leaders, health-care providers, consumer groups and the public at-large all strongly support. On the day of the governor’s announcement, Rob Fowler, president of the Small Business Association of Michigan (generally considered a conservative group), was at the governor’s side. Since that time, chambers of commerce around the state have endorsed the concept and the Michigan Chamber has testified in favor of the expansion.  Public opinion polls similarly show Michigan citizens are overwhelmingly in favor.

So where does the Medicaid expansion in Michigan stand now? Mired in the political process — a process that doesn’t seem to be reflecting the views of any major constituent group, the public or the multiple independent economic analyses that have been done about this expansion and its benefits to the state.

The governor has been working hard to get this done and take advantage of the millions of dollars in federal money that the expansion would bring to the state to improve the health of Michigan citizens and the state’s business climate. He has renamed the expansion the Healthy Michigan program to signal a different type of approach. He has agreed to establish some level of cost sharing in the program so recipients do more to participate in their own care, and he has offered to work with legislators on creative approaches to wellness in Medicaid. He has not supported legislators’ ideas of limiting coverage to 48 months —an idea that health care providers and business leaders also don’t support — because it is unlikely to pass federal scrutiny and doesn’t make sense when it comes to an insurance market or how health care utilization actually works.

There appears to be only a minority view in the state that expanding Medicaid would not be good for Michigan. And, every year of delay costs Michigan millions. The 100 percent federal financing of Medicaid is only good for 2014- 2016.  If Michigan misses the 2014 window, we permanently lose out on one year of 100 percent federal funding -- even if we decide to expand Medicaid later.

There have been some recent promising developments in the state House. The core question is: Do these signs show that the full Legislature is ready to support the governor's Medicaid plan? Or will legislators instead be driven by a minority view that ignores one of the state's most diverse coalition of stakeholders all united in support of the governor on this issue?

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Thu, 06/13/2013 - 8:40am
Please explain exactly what happens AFTER 2014-2016 100% Federal Financing. What happens then? Who exactly will do the financing going forward?
Sun, 06/16/2013 - 8:35am
I am still waiting for an answer. I think this is a very important question that must be answered to get the entire picture: Looking beyond 'Euphoria til 2016' , HOW and WHO will fund Medicaid? Anyone, or a follow-up report to this article addressing this issue would be appreciated.
Charles Richards
Thu, 06/13/2013 - 6:08pm
Ms. Udow-Phillips says, " By expanding Medicaid, people will have access to primary care doctors, saving Michigan hospitals those uncompensated care costs." This is not the case. Many doctors decline to take Medicare patients because of the low compensation, and Medicaid pays even less. And even if they were willing, where would we find the additional doctors to care for the additional "approximately 290,000 in 2014 and 620,00 by 2020."?
Fri, 06/14/2013 - 2:07pm
What sovereignty will Michigan surrender to the Federal government to accept the Medicaid expansion? What new rules and regulations will Michigan have to abide by or lose Federal funding for Medicaid?
Mrs. A
Mon, 06/24/2013 - 9:19pm
@AMM - perhaps the author figured you could do a little research on your own. But to answer your question about what happens in the future: "The newly eligible FMAP (described in section 1905(y)(1) of the Act) is 100 percent in calendar years 2014-2016, 95 percent in calendar year 2017, 94 percent in calendar year 2018, 93 percent in calendar year 2019 , and 90 percent in calendar years 2020 and beyond. " FMAP stands for "federal medical assistance percentages" for states, or the amount the federal government will subsidize, provided they adopt the adult group. Here is the link I souced, and it contains much more information that may be useful if you still have questions.http://medicaid.gov/State-Resource-Center/FAQ-Medicaid-and-CHIP-Affordab...@CharlesRichards - As you point out there is an ongoing shortage of primary care physicians in our nation, however Medicaid patients will be able to access lower cost neighborhood and storefront clinics, seeing physician assistants and nurse practitioners for most complaints, and being referred to supervising MDs and specialists as needed. There will likely be many changes in the medical education system in coming years. @Neil - Michigan will not surrender ANY sovereignty to the Federal government by adopting the Medicaid expansion. In fact it was designed to allow the state to take development money and figure out the best system for its citizens. It's the states that do NOT opt to create they own system that will have the feds do it for them. The ACA is complex -- as you might expect for a law governing 1/7 of America's GNP -- and worth studying up on. Thanks.