LANSING – The bill to expand and reform Michigan Medicaid finally passed the Senate by a vote of 20-18 in a dramatic vote Tuesday night after supporters fell a vote short in a vote earlier in the day.

All 12 Senate Democrats voted to support HB 4714 along with eight Republicans ? Sen. Tom Casperson of Escanaba, Sen. Mike Kowall of White Lake Township, Sen. James Marleau of Lake Orion, Sen. Goeff Hansen of Hart, Sen. Roger Kahn of Saginaw Township, Senate Majority Leader Randy Richardville of Monroe, Sen. Tory Rocca of Sterling Heights and Sen. Howard Walker of Traverse City.

It was Casperson who proved most critical after he surprised supporters of expansion by voting no in the first vote a day after he had said he was leaning yes. After about two hours of tension and closed-door meetings, the Senate adopted an amendment offered by Casperson to secure his yes vote on the bill.

The first vote saw the bill fail 19-18. Sen. Patrick Colbeck (R-Canton Township) had abstained, denying the bill a 19-19 tie that would have allowed Lt. Governor Brian Calley, a bill supporter, to break the tie.

Passage came after a months-long push by Governor Rick Snyder, Democrats and virtually all interests other than tea party groups. While backers have said increasing Medicaid eligibility to 133 percent of the poverty level, as provided under the federal Patient Protection and Affordable Care Act, would make a huge dent in the number of uninsured residents by making more than 400,000 more residents eligible, some Republicans have said the state should reject anything tied to the Affordable Care Act, which they call Obamacare.

The Senate adopted a new S-9 substitute that maintained the fundamentals of the bill ? increasing eligibility, requiring Medicaid beneficiaries to contribute and more.

The S-9 pulled back on language in the S-7 reported by the Government Operations Committee that said hospitals participating in Medicaid that provide care to uninsured persons with incomes up to 500 percent of the federal poverty level would be reimbursed at 115 percent of the Medicare reimbursement rate. Under the S-9, that reimbursement limit would only apply for uninsured persons with incomes up to 133 percent of the poverty level, the same as the House-passed version.

However, the Senate later adopted an amendment making it so that hospitals would have to pay for the 115 percent of Medicare rate reimbursement level for the uninsured that are up to 250 percent of the poverty level. Casperson sponsored the amendment.

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