LANSING ? Michigan House Republicans unveiled Thursday a bill setting conditions for expanding Medicaid to 133 percent of the federal poverty level, but their call for a 48-month limit on Medicaid benefits for some recipients alarmed Democrats and other organizations that had supported expanding the program without conditions.
For HB 4714 , introduced by Rep. Matt Lori (R-Constantine), to work, the federal government would have to approve a massive waiver. The bill would give nondisabled adults (defined as those between 21-65 years old) the choice of going onto Medicaid or obtaining private insurance. It would develop incentives for healthy behavior and reporting fraud and abuse in the program.
The bill’s 48-month limit would apply prospectively, so previous time on Medicaid prior to the expansion taking effect would not count against Medicaid beneficiaries.
House Speaker Jase Bolger (R-Marshall) said the limit is consistent to other programs that the federal government offers including food assistance, unemployment and now housing assistance.
“It is unique,” Mr. Bolger said of the limit. “We are not aware of that being introduced anywhere else in the country. I would pause to say that we have sought to do is take the best of Indiana, the best of Arkansas and add Michigan criteria to that.”
Ever since the Supreme Court declared last year that the federal government in the Affordable Care Act could not force states to expand Medicaid, the question has loomed over Michigan about what it would do. Governor Rick Snyder embraced the expansion, but majority Republicans in the Legislature, who loathe the act Republicans call Obamacare, have resisted.
For some time, it appeared, the question was how to find enough Republicans to match with minority Democrats to pass the expansion. Based on Thursday’s proposal, now the question is whether there are enough votes in the House and Senate Republican caucuses alone to pass the proposal. Democrats denounced the legislation, mainly over the time limit.
House Republicans made a big effort to relabel the proposal as “reform” not “expansion.” Bolger, Lori and Rep. Al Pscholka (R-Stevensville) conducted most of the presentation to Senate Republicans.
Senate Majority Leader Randy Richardville (R-Monroe) said he asked his members during their Thursday retreat to digest what they had heard and expected the conversation to continue into next week.
“I think there’s a sincere effort to respond to the federal government with conservative principles,” Richardville said. “If we’re going to consider this, let’s consider it as a hand up rather than a handout.”
He said he expects some discussions and debate about the 48-month limitation.
“We don’t want to promote a lifestyle of Medicaid, but we don’t want to turn away people who need the service,” he said.
Sen. John Moolenaar (R-Midland) said he had not read all of Mr. Lori’s bill, but commended Lori and Pscholka for getting the ball rolling on the discussion. He said he was not aware of any other place in the country that had a certain kind of limitation on how long certain recipients could receive Medicaid in the way the bill suggests.
“I think the key question is with any type of waiver request it’s a question of what is the governor willing to support (and) what will CMS accept,” Moolenaar said, referring to the Center for Medicare and Medicaid Services with the federal Department of Health and Human Services overseeing Medicaid expansion. “Any discussion of Medicaid reform needs to be based around that concept.
“I think the main component of health savings accounts, some kind of a contribution towards a premium and (encouraging healthy behaviors) are all part of the discussion that … would come under significant scrutiny, as well as from CMS,” he said.
As for his take on how Senate discussions went on Thursday, he said he thought people in general were encouraged by the “outside the box thinking about how reforms could take place” but added that the bill is still at a very early stage in the legislative process so far.
The bill also would end the expansion, and stop spending the federal dollars, for nondisabled adults if federal support for the expansion falls below 100 percent. Under the Patient Protection and Affordable Care Act, the federal government would only fund 100 percent of the Medicaid expansion until 2017. During a period of years, the state would have to ratchet up support until contributing 10 percent of the cost.
Bolger said the Republicans are pursuing the reforms and expansion through a statute because if the federal government changed the rules those dollars could not be spent.
He said once the federal government starts paying less than 100 percent, the Legislature will have to go back to the statute and approve whatever deduction in payment is proposed.
The bill also would require nondisabled adults to contribute no more than 5 percent of their annual income to their coverage, whether through co-pays, deductibles or premiums, although the Department of Community Health could grant exemptions based on ability to pay.
Bolger said contributions to the program add to personal responsibility. He also said as a recipient gets healthier and listens to their doctor by losing weight or quitting smoking, their premiums and copays would decrease.
“We’re putting people back in control,” he said. “We are rewarding people for following their doctor’s orders.”
The Snyder administration welcomed the proposal without embracing all the specifics.
Community Health Director James Haveman said he received the proposal the same time as everyone else, Thursday afternoon, and department officials are reviewing it. Haveman said the key development is to have an actual bill introduced.
“We’re sitting back, taking a look at it, seeing the parts of it which are consistent with what we think the proposal that the governor made in his budget presentation,” he said. “Let the process begin.”
Haveman said of the 1.8 million now on Medicaid, two-thirds are disabled or children. He said officials would have to inquire with the federal government about whether a time limit is legal. He has asked DCH staff to analyze the duration of people on Medicaid.
Asked whether the administration could support a time limit, Haveman echoed the mantra of his boss, Snyder: “I’m a relentless positive action guy, I’m not going to say no to anything until we check out the facts.”
On Medicaid recipients contributing, Haveman noted that able-bodied adults now have co-pays and there is a premium with the MIChild program. However, he said the concept has some merit.
“The positive part for me is we now have a bill to react to,” he said. “I’m sure as we analyze this we’ll have some questions, might want some clarification and maybe some concerns.”
House Minority Leader Tim Greimel (D-Auburn Hills) criticized the proposal in a statement, saying it offers only “token assistance to people in desperate need of health care while requiring working poor families to spend up to 5 percent of their annual income on a watered-down health plan.”
“This plan is a slap in the face to anyone in desperate need of health care who had hoped our state would do the reasonable thing and accept federal funds to expand Medicaid,” Greimel said. “We should have done the responsible thing and accepted federal funds to pay for Medicaid expansion, bringing health care to 400,000 Michigan residents who currently have none.”
Katie Carey, spokesperson for the House Democrats, said the proposal isn’t “dead” within the caucus. Carey said they will look at proposal and possibly come back to the Republicans with portions they can support.
Carey said the majority of concerns will stem from the 48-month limit.
“This is different than capping welfare benefits,” she said. “There isn’t a constant we can control in this situation.”
Robert McCann, spokesperson for Senate Minority Leader Gretchen Whitmer (D-East Lansing), said he had only briefed the bill but had some concerns about the limitation portion as well.
“Our immediate concern is clearly they’re playing politics with this. The question I would have is, are they being legitimate?” McCann said. “Is this more posturing or is it the beginning of an attempt to make Medicaid expansion happen, because at face value I don’t know that it is.”
Pscholka, who worked with Lori on the Medicaid reforms, said the Republicans refuse to expand a program that is not working well.
“Instead of expanding an open-ended federal entitlement, we found a way to reform the system and cover more people with better coverage, all at a cost savings to Michigan taxpayers,” Pscholka said. “This plan will help Michigan residents become healthier, and it won’t leave taxpayers on the hook down the road.”
This story was provided by Gongwer News Service. To subscribe, click on Gongwer.Com
