A news service for the people of Michigan from the Mackinac Center for Public Policy

Sen. Randy Richardville, R-Monroe; Sen. Tory Rocca, R-Sterling Heights; Sen. Jim Marleau, R-Lake Orion; Sen. Mike Kowall, R-White Lake; Sen. Roger Kahn, R-Saginaw; Sen. Geoff Hansen, R-Hart; Sen. Howard Walker, R-Traverse City; Sen. Tom Casperson, R-Escanaba

A Medicaid expansion bill passed in the state Senate late Tuesday, but only after it first failed.

Just after 8 p.m. Tuesday, the Senate voted 20-18 to pass a Medicaid expansion bill (House Bill 4714) and move the key Obamacare provision closer to reality in Michigan. If enacted, the legislation would place Michigan among the states that are cooperating with the implementation of Obamacare, which Republicans almost universally say they oppose.

Unless the House fails to concur with the Senate version of the bill, it will be sent to Gov. Rick Snyder for his signature. That vote on concurrence is expected Tuesday, Sept. 3. Gov. Snyder asked for the legislation and has already said he’ll sign it into law.

In June, the House passed its version of the bill when House Speaker Jase Bolger, R-Marshall, allowed the Democrats to supply most of the "yes" votes for the bill. Twenty-eight House Republicans, including those in leadership, voted with the Democrats.

That same dynamic was the key to the Senate's passage of the bill Tuesday night. Senate Majority Leader Randy Richardville, R-Monroe, let the Democrats supply the bulk of the votes needed. Previously, he had refused to hold a vote on the bill without a majority of Senate Republicans backing it.

Eight Republicans joined the 12 Democratic senators who voted "yes," which pushed the bill forward after Sen. Tom Casperson, R-Escanaba, flipped from an earlier "no" vote.

In addition to Sens. Richardville and Casperson, the GOP "yes" votes were: Sen. Mike Kowall; R-White Lake; Sen. Geoff Hansen, R-Hart; Sen. Jim Marleau, R-Lake Orion: Sen. Tory Rocca, R-Sterling Heights; Sen. Howard Walker, R-Traverse City; and Sen. Roger Kahn, R-Saginaw.

On the initial attempt to pass the legislation, Sen. Patrick Colbeck, R-Canton, used a procedural move to keep the measure from passing. Sen. Colbeck withheld his vote, thus avoiding a 19-19 tie, which would have allowed Lt. Gov. Brian Calley to cast the tie-breaking 20th vote for passage.

That maneuver temporarily threw a monkey wrench into the plans of Medicaid expansion proponents. The question then turned to which Republican would be willing to switch their vote and become known as the person who put Medicaid expansion over the top.

After the Senate Republicans caucused, Sen. Casperson offered an amendment to the bill to limit the amount that hospitals could charge uninsured patients. After his amendment was adopted, he switched his vote to "yes."

Sen. Casperson represents an Upper Peninsula district. He's expected to run for re-election in 2014 and possibly run for Congress in 2016.

"We're standing here before yet another attempt to expand Obamacare," Sen. Colbeck said during the floor debate prior to the vote being taken. "The expansion of Medicaid is a key part of Obamacare. It's nothing short of government control of health care and they're primarily putting people into Medicaid, which is not quality care. Peer-reviewed studies have shown that being on Medicaid doesn't result in health care outcomes that are any better than not being insured.

“Hitching our wagon to the Obamacare train is very risky," Sen. Colbeck continued. "The bottom line is that we'll be spending more money. This is an increase in spending and the funding available will be coming in for four years. In the fifth year we'll start on a downward trend. We're going be spending money we don't have because of a decision for political expediency."

Sen. Mike Green, R-Mayville, attacked the bill as well.

"This legislation does five things," he said. "It is a critical component of Obamacare. It is a massive expansion of government. It is funded by billions of federal dollars, when the federal government is $17 trillion in debt. It kicks the can down the road for those in the future to deal with. And it does nothing to advance quality health care.

"Once again we're dealing with the promise of federal funny money," Sen. Green said.

Sen. Kahn argued for the expansion of Medicaid.

"This is our bill, our bipartisan bill that will reform the cost of medicine throughout the state and become the model in the country," Sen. Kahn said. "This bill becomes a hand up, not just a hand out."

Sen. Walker also spoke in support of House Bill 4714

"The Affordable Care Act, also known as Obamacare, is in my opinion the worst legislation passed in many years," Sen. Walker said. "But, whether we like it or not, Obamacare is here to stay, at least until he have a new president or possibly a new [U.S.] Senate."

Sen. Walker also repeated the claim of those who support House Bill 4714, that the legislation includes "trigger points" that would allow Michigan to get out of the expansion, if it chose to do so at a future date.

However, that claim is a fallacy, said Jack McHugh, senior legislative analyst with the Mackinac Center for Public Policy.

"No one should be fooled," McHugh said. "The supposed 'reforms' are just a cover story for what this is really about — delivering a massive revenue stream to the politically powerful hospital cartel, to be paid for by our children and grandchildren. In particular, the notion that a future legislature will rescind the expansion if the feds don't approve a 48-month benefit cap is laughable. The feds won't approve it and this state won't undo the expansion for political reasons, even if undoing it were possible legally, which it probably isn't."

Sen. John Moolenaar, R-Midland, argued that the claims of Medicaid expansion advocates that the bill was about Medicaid reforms didn't stand up to scrutiny.

"Does House Bill 4714 truly reform Medicaid?" Sen. Moolenaar asked rhetorically. "What it does it tell the Department of Community Health what waivers it should ask the federal government for; it's just the opening bid. A wise financial adviser once said, 'The borrower is a slave to the lender.' "

House Speaker Bolger issued a press release in which he applauded the action taken by the Senate.

"Lack of insurance is a very real problem facing many working families in Michigan," his prepared statement said. "Mounting debt and higher federal taxes are a very real problem for all Americans. While the Affordable Care Act, referred to as 'Obamacare' by many, is neither affordable nor will it improve care, it is the law of the land. As state legislators, we were left to deal with how best to serve Michigan's patients and taxpayers whether we agree with the law or not."

Sen. Casperson said he changed his "no" vote to a "yes" because of an amendment he was able to pass that he says will address uncompensated care.

“It will not allow hospitals to charge triple what the normal rate would be," Sen. Casperson said. "If you come in without any health care ... what happens is the hospital bills you for what I would say [is] an exorbitant  amount.”   

He also suggested that under expansion, more doctors would participate because Medicaid reimbursements would improve.

Sen. Richardville said it was a tough vote because of the "big spectrum of beliefs" among the 26 Republicans.

“I don’t think any of them didn’t vote their conscience tonight,” he said.

Sen. Richardville added that not initially having the votes was a "misunderstanding."

“I was surprised by the Casperson 'no' vote because we had some conversation," he said. "There was a misunderstanding. I take the responsibility for it.”  

He explained that Casperson wanted to discuss a concern before the first vote but Richardson didn’t get the message and they didn’t meet. He said there were no threats by his caucus to fire him as leader.

“I can’t see anything of this magnitude coming back up again.”  

Editor's Note: This story has been updated with more comments since it was originally posted.

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See also:

New Medicaid Study: 'Waivers Are Temporary, Expansion Is Forever'

Brain Surgery Required After Medicaid Issue Delayed Dental Care

Michigan Doctor: Medicaid Pays Way Below What It Costs To Take Care of Patients

The Real Patients of Medicaid: Teraca

Medicaid Recipient: 'When I ask where I'm suppose to go, I'm told the hospital'

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