LANSING – Governor Rick Snyder said he hoped the state could be a model for the rest of the nation as he signed legislation Monday expanding Medicaid coverage under the federal Patient Protection and Affordable Care Act.
The bill (HB 4714 , PA 107) is projected to allow 470,000 residents to join Medicaid, pending approval of federal waivers for some requirements placed on those new recipients.
“This wasn’t just about access,” Snyder said on signing HB 4714, saying the measure had to do with “cost, quality and access.”
“It is because of the legislation the governor is about to sign shortly that we know the 26,000 men and women who came to us last year will be able to come back to us with confidence, with peace of mind,” Brian Connolly, president of Oakwood Healthcare Systems, said of the uninsured patients treated at the system’s two hospitals and various clinics around Wayne County over the past year.
The change will allow those patients to see a family doctor rather than go to the emergency room, Connolly said.
Now that the legislation has been signed, the real work will begin, Snyder said.
The first step is getting federal permission to make changes to Medicaid.
“We’re working with the federal government on putting together waivers,” the governor said. “So far that’s going well.”
The bill sets up incentives for the Medicaid health plans that meet certain population goals; providers that meet quality, cost and use targets; and beneficiaries who maintain healthy behaviors. The Department of Community Health would be limited to administrative costs of 1 percent of the medical assistance program to administer Medicaid.
Further, those with incomes between 100 percent and 133 percent of the poverty level would have to contribute an amount equal to up to 5 percent of their income once they have been on Medicaid for six months through their first 48 months in the program. Participants would contribute 2 percent toward incurred health expenses although the insurer could reduce this amount if the person is adhering to specified healthy behaviors.
After 48 months, cost-sharing would rise to 7 percent with participants having to pay 3.5 percent of incurred health expenses, subject to reductions as seen fit by the insurer.
“We need to look at fundamental reforms of the cost structure of health care,” Snyder said, adding the bills include personal responsibility as well as financial security for those receiving the benefits.
To those who were concerned about state and federal expansion into health care, Snyder said the plan as designed is more efficient. “We shouldn’t get bogged down about who’s writing the checks,” he said.
“We were successful in getting this to the point where I believe this will get us reliability, accountability and personal responsibility,” Rep. Mike Shirkey (R-Clarklake) said, noting he was initially opposed to the Medicaid expansion, and the federal health care law in general.
U.S. Rep. John Dingell (D-Dearborn) urged other Republicans to join Snyder in support of the federal health care law.
“I’m kind of looking at framing this with the picture of my dad with Franklin Roosevelt when he signed the Social Security Act because it’s going to rank with that,” Dingell said of the photos taken with him and Mr. Snyder as the governor signed the bill.
He acknowledged there were ways to improve the federal law. “We should be taking the governor’s course of trying to ferret those (problems in the act) out and correct them,” he said. “Let’s for the love of God understand that we have to work together to make our government work.”
Dingell said the federal law was projected to reduce uncompensated care, currently projected at $1,000 per person, by $320 million annually by 2022.
Sen. Roger Kahn (R-Saginaw Township), a key backer of the plan, said the bill also includes studies that could point out ways to save more in the future.
There will also be work ahead to get people signed up for the benefits, Snyder said. “We have to educate people. This is one of the most confusing situations known to man,” he said. “There’s a tremendous amount of misinformation and misunderstanding that needs to be cleared up in the next few months.”
The bill gives the state a little longer to reach residents. Because it was not given immediate effect, the new benefit does not open until the end of March, despite the federal law allowing the benefits to start January 1.
There was no talk Monday of the estimated $7 million in federal funds the state would lose each day between January 1 and the effective date of the bill, an argument unsuccessfully made to urge the Senate to give the bill immediate effect.
Snyder did refer to some efforts he made to get the Senate to take up the bill before it left on summer break. “I did catch a lot of grief for some of my comments, but hopefully that’s all behind us now,” he said.
