LANSING – After a lengthy session by the House to pass a Medicaid reform bill that attempts to align the desire of Governor Rick Snyder to expand the program using federal money while making reforms some say are needed, members of the Senate are now reviewing that result and in the process of deciding how they will vote on the bill.

“I’ve always been conflicted about it,” Sen. Howard Walker (R-Traverse City) said of expanding Medicaid. “I see pluses and minuses.”

Walker said on one hand, the expansion helps to include health care for many people who are doing the right thing by earning a living the best they can but can’t quite attain health insurance on their own, and that merits consideration, he said. But on the other hand, he said he found it ironic that the federal government under the Affordable Care Act is cutting into Medicare to pay for the Medicaid expansion, and that brings to question the level of commitment from the federal government.

For the most part, Senate Republicans, who boast a two-thirds majority in the chamber, have been hesitant about incorporating in Michigan any policy that could be associated with the Affordable Care Act or relies on federal money, most often expressing discontent over the federal deficit and sequestration. As such, garnering support for HB 4714 could prove to be an uphill battle.

Those following the issue have long said the Senate was the tougher vote, not the House. The plan passed by the House was largely developed by House Republicans, not Senate Republicans.

After the House passed the bill just after 9:30 p.m. on Thursday (See Gongwer Michigan Report, June 13, 2013), already two senators had come out with criticism. Sen. Patrick Colbeck (R-Canton Township) fumed in a post from his Facebook page, “A YES vote on Medicaid Expansion is a YES vote at the state level for Obamacare.”

And from his Facebook page, Sen. Joe Hune (R-Hamburg) said, “The State House just passed the Obamacare Expansion in Michigan adding another half million people to the Medicaid Rolls…Heaven Help us!”

Sen. Mike Green (R-Mayville) has previously made several statements on the Senate floor regarding his discontent for federal handling of various policies, calling money for the health care exchange, for instance, “funny money.”

But not all Senate Republicans share the same sentiment on the Medicaid policy. Sen. Roger Kahn (R-Saginaw Township), a physician himself, has been one of few Republicans to express support for expanding Medicaid, and even fewer to be vocal about it.

“It’s a good start. It’s more than a good start. It has a pathway to getting this done. I’m reading it over and looking at it,” Mr. Kahn said of the bill. “I have some thoughts and things that could be improvements. Several others are thinking about this and reading it tentatively, and we’ll be discussing it further among ourselves, with the House, and with the administration too.”

When the issue of expanding Medicaid and doing so in the state’s fiscal year 2013-14 budget was last discussed, Kahn and other senators, including Sen. John Moolenaar (R-Midland), chair of the Senate Appropriations Community Health Subcommittee, spoke at length about a sort of Healthy Michigan initiative, modeled after the already-established Healthy Indiana. In short, a Healthy Michigan program would provide various incentives for people to take charge of the betterment of their own health and in return possibly receive lower co-pays, as a start.

The House bill as written does contain some language encouraging healthy behaviors and healthy living, but Kahn threw out several other concepts to consider in that realm, including enhancing substance abuse prevention and emergency room utilization. He also suggested expanding possible providers and making sure the bill is compatible with existing law in the state that provides mental health benefits to folks with Medicaid.

“The more incentives that we have for people to be healthy, not only the healthier will they be but the more cost effective the delivery of care will be,” Kahn said. “This should be a primary focus of Medicaid reform, and if you want one word of what this is all about, it’s reform.”

Walker was a little less certain about improvements or changes to the bill.

“I think given the work that was done in the House, which made the bill and the proposal a lot more on the positive side, I don’t know how much changes are going to be able to be affected on the Senate side,” Walker said. “It would be nice to have something tied to the waivers. If we can’t get the waivers, are we stuck with the bad parts of the legislation or do we get out of all of it?”

And Moolenaar said that while he very much respects the work that was done by the House, “any way you look at it, it’s Medicaid expansion,” he said. Moolenaar has previously stated concerns about expanding the program, specifically as it relates to sustainability. He said when he first came to the Legislature in 2003, between one and eight and one and nine residents were on Medicaid. Now, he said, that statistic is at one in five, and with an expansion could be one in four.

“I think a lot of good work has gone into it in terms of proving the proposal. If someone wanted to expand Medicaid, there’s a lot of reform in the package,” he said. “On the other hand, I don’t favor the expansion, so I won’t be voting for it.”

Asked if anything could be included in the bill that would change his mind, Moolenaar said: “I’ve continued to learn as much as I can about the positives and negatives, and I came down on the side of concerns of financial sustainability. At a time when we have $17 trillion of federal debt and a growing future requirement on the state (to pay for the expansion), that is the concern.”

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