No explanation for June’s sudden Medicaid expansion reversal
In early June, several remarkable events related to the Obamacare Medicaid expansion occurred in the Republican caucus of the Michigan House of Representatives.
GOP members had opposed Medicaid expansion all year, but suddenly their leadership team headed by Speaker Jase Bolger flipped from promoting legislation that would have made expansion unlikely to supporting a substitute bill that (if Senate Republicans concur) makes it all but certain.
More remarkably, Speaker Bolger then rushed the substitute version to a vote of the full House, even though a majority of his caucus opposed the measure and voted against it.
House Democrats provided the lion's share of the votes needed for passage. Moreover, the vote occurred with little fuss or floor debate, and with not one of the bill's GOP opponents offering amendments that might have stalled or prevented its adoption.
Those events raise troubling and unanswered questions. No explanation has been offered for the 180 degree flip, or for why Speaker Bolger broke the "Hastert Rule" of not bringing a bill to a vote unless a majority of his own caucus is on board (reportedly this was just the third time he has done so since becoming Speaker in January 2010).
Instead, House Republican leadership joined the Snyder administration in an astounding spin campaign, which among other excesses has actually attempted to wrap this key Obamacare component in the mantle of "Reagan conservatism."*
As background, Michigan's hospital cartel has been applying tremendous pressure on legislators to support the expansion. It's members stand to gain billions of dollars in managed care contracts from the state.
Until June, the Republican caucuses had resisted the pressure. When an expansion bill was introduced on May 9 it was filled with "poison pill" conditions the Obama administration would never accept, most notably a four-year cap on how long non-disabled individuals could collect benefits. Importantly, the bill required the feds to give permission for this and other reforms before money could start flowing to the hospitals.
The legislation almost appeared to be a cover story intended to let Republicans tell their local hospitals that they had voted for the expansion, while at the same time communicating to conservative GOP primary voters: "Not to worry, under this bill the expansion will never actually happen."
As one liberal blog put it: "Don't let the Michigan House GOP fool you. They don't really want Medicaid expansion in Michigan. They just want you to think they do."
For a few weeks House Republicans from Speaker Bolger on down showed impressive discipline in denying such claims, even as respected experts testified in hearings that a 48-month benefit cap was dubious under current law and had no chance of being approved by the Obama administration.
They were just as firm on the Senate side. When MIRS News asked Majority Leader Randy Richardville what would happen if the feds said "no way" on the 48-month cap, he responded: "Well, then I guess we'll say, 'no way' (and) move on to something else." Referring to the cap he told the Detroit News: "If we take this money, it's not going to be on their terms, it's going to be on our terms."
In that same June 1 story, House Speaker Bolger denied that the 48-month cap was a recipe for no expansion: “That's absolutely untrue,” he said. “What we've put forward is very reasonable.”
But a few days later the leadership cracked. On June 7 a new version of the bill was released that was a recipe for Medicaid expansion, with no 48-month benefit cap, and importantly, no requirement that the feds approve the substitute's more modest reforms before money could start flowing to the hospitals next January.** Just six days later the Speaker brought this version up for a vote by the full House and it passed, with 30 out of 59 Republicans voting "no" and all but one Democratic voting "yes.” (Who Voted "Yes" and Who Voted "No")
As mentioned, no floor amendments were offered, and to this day no leader or leaders have emerged to rally the majority of House Republicans who oppose Medicaid expansion. While interpersonal caucus dynamics generally make majority members hesitant to offer hostile amendments to bills supported by the leadership, that convention doesn't apply when more than half the majority caucus opposes a measure. It's almost as if rank-and-file House Republicans were surprised to discover that most of their fellow caucus members were not on board the leadership's decisions.
They were probably even more surprised when Senate Republicans refused to go along with the capitulation. Majority Leader Richardville let it be known that he would not violate the "Hastert Rule," so unless a majority of GOP Senators supported the bill it would not be brought up for a vote. Apparently a majority did not support it, because on June 27 the body adjourned for a summer recess with no vote taking place.*** On Wednesday, the Senate Government Operations Committee moved forward three Medicaid expansion bills, with a potential vote coming in late August.
All this has left many Lansing insiders scratching their heads, and many base GOP voters wondering whether the party's representatives in the Legislature have reverted to the bad-old establishment bias that often prevailed before the 2010 tea party election supposedly turned Republican caucuses in a more populist direction.
Summing up the unanswered questions:
- What accounted for the 180 degree reversal that occurred between June 1-5, when House leadership flipped from loudly defending a recipe for no expansion to even more vigorously promoting legislation that all but guarantees it?
- When Speaker Bolger brought the bill to vote on House floor, did rank-and-file Republican members believe that a majority of their caucus was on board?
- When it became clear during the vote that most Republicans opposed passage, why did none of the opponents move to "clear the board" and offer amendments, including one returning the bill to its original "no expansion" formula? This would almost certainly have brought the vote to a halt.
- Did the House Republican leadership mislead members into believing the Senate GOP caucus was ready to pass the bill, when in fact it was not?
- Has the hospital lobby made any promises (or threats) to the House or Senate caucus campaign committees, or to individual members?
- In the weeks since, why have none of the House Republicans who voted "no" emerged publically to rally the majority of their caucus who voted against the expansion, and to systematically counter the intense spin their leadership has put forward to advance it?
The last item — the absence of a leader or leaders to rally the House Obamacare implementation opponents — applies in particular to members whose names have been mentioned as potential candidates to become the next House Speaker when Bolger is termed out of office at the end of next year. Among those are expansion no-voters Reps. Kevin Cotter, Tom Leonard and Aric Nesbitt. The potential Speaker list also includes expansion yes-voters Reps. Al Pscholka, Lisa Lyons and Frank Foster. (A list casting a wider net includes expansion opponents Reps. Jeff Farrington and Peter MacGregor, and expansion yes-voters Reps. Mike Shirkey, Ken Yonker and Earl Poleski.)
It all remains a great mystery. Readers should note that the Michigan Legislature is not required to take any vote or pass any bill related to the Medicaid expansion. No less an authority than the U.S. Supreme Court has decreed that doing nothing is a perfectly valid option.
If this key component of Obamacare implementation is adopted here — propping-up this harmful law just as it is becoming increasingly vulnerable — these unanswered questions are likely to prove troublesome for a long time to the Republicans who approved it, and to the larger party establishment.
* A personal observation based on 20 years experience in Lansing legislative affairs: When the spin gets this deep it's all but certain the real issue is about money, not policy, because policy arguments never get this whacky. The money in this instance is the $3 billion-plus annually that will start flowing to hospitals next year if the Legislature approves the expansion.
** Some ambiguous language in the substitute let some of its supporters claim otherwise, but key provisions only made sense if no advance waiver approvals were required. This is how the fiscal agencies scored it and how the mainstream media reported it, with no objections from the GOP leadership team.
*** This group’s product was recently released and like the House-passed version appears to be a recipe for expansion. It contains a provision asking the feds to allow a 48 month benefit cap, but critically, does not require this to be approved before the dollars start flowing. No one in Lansing or Washington believes that once the money is flowing the Legislature will ever summon the will to stop it. The one waiver request the Senate bill does require to be approved in advance appears to involve matters that won’t trouble the Obama administration.