Representative examines the proposed State of Michigan Medicaid expansion

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By NANCY JENKINS
State Representative
R-Clayton

Around this time last year, the U.S. Supreme Court upheld the Patient Protection and Affordable Care Act, better known as Obamacare, affirming it as the law of the land. Like many of you, I was disappointed in this decision. As health care costs continue to skyrocket — leaving many Michiganders unable to afford even basic coverage — it is clear that major, meaningful health care reforms are needed. However, Obamacare does not provide those reforms.

Originally, Obamacare mandated that every state expand its Medicaid program to cover all those earning less than 138 percent of the federal poverty line. But the Supreme Court changed that ruling last June, giving individual states the option of whether to expand.

Recently, a bill was introduced in the House of Representatives that would have done just that. House Bill 4714 was designed to reform the Medicaid system in our state, expanding coverage to more people in the state and increasing the eligibility for federal assistance. It was passed by the House in June, but ultimately, I could not support House Bill 4714 in good conscience.

The reason for my “no” vote on Medicaid expansion was based on the need to look for a long-term fix for the people of Michigan rather than putting a Band-Aid on a program that is not working well. While there were some things about the bill that I could have supported, there were also some things that I just could not.

The bill would expand coverage to between 350,000 and 600,000 more people. That’s a sizable increase in the Medicaid population and the number of people dependent on the government for assistance. Even as recently as a few years ago, there was great concern about the size of Michigan’s Medicaid program and the state’s ability to fund it — and under HB 4714, that population would have grown even more.

In fact, in a House Fiscal analysis from 2007, the following concerns were raised about managing Medicaid costs in our state:

“Medicaid is a joint federal-state program that pays for health care services to 1.5 million low-income Michigan residents at an annual cost of almost $9 billion. In the past six years, Michigan’s Medicaid program has dealt with unprecedented caseload levels, federal funding reductions, and declines in state General Fund/General Purpose (GF/GP) revenue that have posed many challenges for the state’s primary health care safety net program.

“As the largest single program administered by the state, and among the fastest growing, Medicaid has placed enormous pressure on Michigan’s budget. Nearly 25 percent of state GF/GP revenue is now allocated to Medicaid; by comparison, only 8.3 percent of state GF/GP was expended on Medicaid in 1980, and 17.5 percent in 1990.”

Under the Affordable Care Act, the federal government has promised to pay 100 percent of the cost of Medicaid expansion in the first three years, and then 90 percent after that. If we cannot rely on the federal government to maintain its funding level in previous years, how can we expect them to maintain that level going forward, especially in light of the size of our ever-growing national debt and the fact that Congress has not passed a budget in years?

With that in mind, it’s worth pointing out that part of HB 4714 included language stating that, if at any time the federal government reduced its funding so low that the state no longer sees savings, or the requested waivers were not approved, the expansion program would be ended, and we would go back to the system we currently have.

There were parts of House Bill 4714 that had their merits, but as a whole, the expansion of an already struggling federal program was not something that I could support. I do not think it’s right to put hundreds of thousands of new people into the program only to strip it away when the feds fail to fully fund it or approve the waivers. I cannot imagine the ramifications of doing that.




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