LANSING – Sen. Roger Kahn on Wednesday presented a Senate Medicaid workgroup proposal that keeps critical components of the House bill to expand and reform Medicaid while ensuring the reforms remain even if federal waivers are not granted or the Affordable Care Act is repealed.

“Besides the ability to opt-out, it was important that we put within the bill that the reforms will continue whether we opt out, whether the affordable care act is repealed, and whether or not the waivers are not granted,” Kahn (R-Saginaw Township) said. “That, I think, is the exclamation point of why this is our Healthy Michigan plan.”

Kahn reiterated several times that the S-7 draft 3 version of HB 4714 should be viewed as the state’s Healthy Michigan plan, not the Affordable Care Act. The plan relies on two federal waivers that make changes in the Medicaid program and provide a path off Medicaid for able-bodied individuals, as well as enrolls individuals and provides an account by which enrollees can pay for their healthcare services, be it co-pays, deductibles, and so forth.

Throughout the draft, the program refers to a contracted health plan-based endeavor, most closely related to a health maintenance organization, Kahn said.

Similar to the House bill, the Senate version would require those on Medicaid with incomes between 100 and 133 percent of the federal poverty level to choose after 48 months on Medicaid whether to purchase health insurance with federal subsidies through the insurance exchange or continue on Medicaid with cost-sharing at 7 percent of income. The Department of Community Health could lower the cost-sharing level to 3 percent.

For the first 48 months, like the House bill, the Senate would set the cost-sharing level at 5 percent. Also like the House bill, there would be no cost-sharing for the first six months.

“Our workgroup focused on ways to improve upon the current legislation by identifying reforms that could be implemented without federal waivers and our ultimate goal was and is and will be a Healthy Michigan,” Kahn said.

HB 4714 passed the House in June on a bipartisan vote, 76-31, with 28 Republican yes votes. The legislation was then handed off to the Senate, which kept the bill on its agenda, but never voted on it by the time it adjourned for summer recess and eventually placed it in the Government Operations Committee.

Many senators have since heard a mouthful about the inaction, too, not only from major proponents of the legislation, but also Governor Rick Snyder and constituents, some who have billboards in their communities. The motto for some time was “Take a vote, not a vacation,” a scathing line from Snyder, but Snyder dropped that line at the behest of Senate Republicans and instead simply encouraged residents to call senators and urge action on the bill.

Within a week of adjournment, Senate Majority Leader Randy Richardville (R-Monroe) appointed at first a six-member, all-Republican workgroup to analyze the bill and make it “more palatable” to the caucus. Not long after, he added two Democratic senators. Since making the appointments, the group has not met publicly nor discussed the details of its findings, until Wednesday.

With most of the Capitol community just getting their first look at the 38-page bill, reaction was relatively muted. House Republican spokesperson Gideon D’Assandro said the House GOP is reviewing the bill and called the Senate’s release of its proposed substitute an important step.

So similar to the House version is the Senate proposal that Senate Democrats questions why majority Senate Republicans needed a month to dissect the issue.

“This workgroup product looks remarkably like the original bill we could and should have voted on two months ago, so while we’re pleased to see the legislation still appears at face value to be something we can support,” said Robert McCann, spokesperson for Senate Democrats, in an e-mail, “it raises the question of why we haven’t taken a vote on it yet and why the Republicans are still not planning on doing so anytime soon. We’re quickly getting to the point where it won’t matter what this bill looks like because it will simply be too late to put the program in place and that would be an absolute disgrace for our state.”

Kahn said there were notable changes in how bonuses would be provided to insurers for good performance as well as setting metrics on how the co-pays would be established. He said he believes the bill “bends the cost curve” of health care in Michigan and addresses issues of access, affordability and quality.

But Scott Hagerstrom, Michigan state director of Americans for Prosperity, a sharp critic of Medicaid expansion was at the news conference and disagreed with the accolades coming from most others in the room, including Mr. Kahn.

“This is a key component to implementing Obamacare, Medicaid expansion,” Hagerstrom said. “Unfortunately Lansing Republicans, mainstream Lansing Republicans, are in race to grab federal tax dollars to implement a broken program and unfortunately they consulted with the political class and Lansing lobbyists to make that happen.”

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