LANSING (AP) – Michigan Gov. Rick Snyder and his fellow Republicans could find themselves knee-deep in health care issues Thursday when lawmakers briefly return after a five-week break.
Snyder needs to get reluctant House Republicans on board with his efforts to create an online site where individuals and small businesses can comparison shop for private health insurance.
He’ll also likely be comparing notes with GOP legislative leaders over whether it will be a good idea in 2014 to extend Medicaid to around 500,000 more low-income residents with the help of $2 billion annually in federal aid.
Both the health insurance exchange and the Medicaid expansion are required under the Affordable Care Act recently upheld by the U.S. Supreme Court. But the court also ruled that the federal government can’t withhold a state’s entire Medicaid allotment if it doesn’t participate in the expansion, and some states now say they don’t plan to cover more residents.
Snyder spokeswoman Sara Wurfel said the governor would like the House on Thursday to follow the lead of the GOP-controlled Senate and approve setting up the exchange.
House Republicans initially blocked the administration’s efforts to tap $9.8 million in federal planning money for the exchange until the court ruled, hoping the law would be struck down. The state has been granted the money but can’t spend it without legislative approval. Nor can it apply for additional federal planning funds if the first grant isn’t used.
Now some GOP House members say any action on the exchange should be put off until November, when they’ll know if GOP presidential candidate Mitt Romney wins the White House and Republicans capture the U.S. Senate, making it possible some parts of the federal health care law will be repealed.
Ari Adler, spokesman for GOP House Speaker Jase Bolger, said it’s unclear if House Republicans will approve the exchange on Thursday.
“There’s a push, obviously, to set up an exchange There is a separate push – if we don’t set one up – that we start some of the planning process,” Adler said. “And then there is a lot of pressure to delay things a little longer. We are receiving a lot of feedback with a lot of different ideas.”
At least one conservative group, Americans For Prosperity-Michigan, has sent campaign literature into more than 20 House districts and three Senate districts trying to discourage lawmakers from approving the exchange or castigating senators who already have.
But Mark Kopson, chairman of the health care practice with Bloomfield Hills-based law firm Plunkett Cooney PC, said the state’s slow pace in setting up the exchange is making it hard to compare coverage offered by private insurance companies.
“Michigan consumers for the most part currently are faced with a black box when they’re trying to evaluate insurance coverages and costs,” Kopson said. “The exchanges would allow them to … make cost comparisons and coverage comparisons between the various plans. I see that as a boon for both individuals as well as small employers.”
The federal government will step in with its own exchange if Michigan hasn’t made progress by mid-November on setting up the online marketplace. Michigan officials are working on a state exchange but also are talking to federal officials about partnering on an exchange where the state handles just part of it.
More than half a million Michigan residents are expected to buy private insurance through the exchange once it’s up and running in 2014, including some who already have coverage. Nearly 1.3 million residents – about 13 percent of Michigan’s population – are uninsured.
On the Medicaid issue, it’s unclear if Michigan eventually will agree to expand coverage to residents who make up to 138 percent of the federal poverty level – about $15,400 annually for an individual and $31,800 for a family of four, according to the Pew Center on the States.
“There’s a really detailed analysis going through … (on) what that would mean if we do decide to opt out of it and all the impacts that could have,” Wurfel said. “The governor feels strongly that this is one of those decisions that can’t be made immediately or lightly, and wants to work with the Legislature on that front.”
Many GOP legislators in Michigan oppose the Affordable Care Act and may be reluctant to expand services.
“We don’t want to get into a situation where the federal government helps us expand the program, and then in a few years there’s not money to address that,” Adler said, adding that lawmakers are “in the fact-finding stage.”
The nonpartisan Senate Fiscal Agency writes that expanding coverage could save the state money, even when it must start paying a portion of the cost in 2017. The law calls for Washington to cover the full cost of the first three years of the expansion, eventually dropping to a 90 percent share by 2020. That’s still far above the average 60 percent federal share of Medicaid costs the federal government currently is paying on average.
“The expansion would lead to some significant savings” by putting many of the residents who get state-paid mental health services into Medicaid, where their services would be covered by federal funds, saving the state $200 million a year, agency associate director Steve Angelotti wrote.
“The decision on whether to comply with the Medicaid expansion will be more of a policy issue than a fiscal issue,” he added.
Advocates for the uninsured say the state could see tremendous benefits from extending access to health care to 400,000 to 600,000 more Michigan residents who no longer would have to rely on uncompensated care at high-cost facilities such as hospital emergency rooms.
“Not only does the Medicaid expansion work to help build a higher quality of health care, but it also helps to reduce costs,” said Phillip Bergquist of the Michigan Primary Care Association, a collection of 34 health centers statewide.
The growth of chronic diseases such as diabetes also could be slowed if more people could get preventative care or help managing their diseases, Kopson said. The state Department of Community Health reports that Michigan rates of infant mortality, cancer deaths, obesity, high blood pressure and smoking are higher than the national average.
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