Focusing on the Big Picture

How Republicans and Democrats view Medicaid expansion

There's an amusing story that demonstrates how focusing too much on one aspect of a situation can obliterate one's view of the bigger picture.

Once there was a lonely magician who went to a pet shop seeking a companion.

 “You're in luck,” the shop clerk said. “We have a parrot for sale that is so smart he can carry on conversations. Just be careful what you teach the parrot in the first few weeks. Parrots are very intelligent, but they have one-track minds. Once the parrot locks in on what you want him to do, he'll never change.”

When the magician brought the parrot back to his apartment he discovered that the pet store clerk hadn’t exaggerated. The parrot was a great companion. It acted like a human being, carrying on conversations, asking and answering questions.

From the start, the magician's favorite activity with the parrot took place as he practiced his magic tricks. The parrot was fascinated by the magician’s tricks. He studied every move and asked the magician to repeat each trick. For the magician, this was like having a built-in audience.

Over time, the parrot always figured out how each trick worked, which gave the magician an incentive to find new tricks. As a result, the magician's act steadily improved.

Then the magician was hired as an entertainer by a Caribbean cruise company. Obviously, he couldn't leave the parrot in his apartment for weeks on end, so he took the parrot with him.

On the first night out from port, the cruise ship struck something. Soon it became clear that the ship was sinking.

Because he was an employee of the cruise company, the magician had to wait and make sure all of the passengers were safe. As things turned out, the ship sank before he could climb into a life boat. He ended up in the water, clinging to a piece of floating debris.

The next morning the magician was delighted when he spotted his parrot circling in the air. After a few minutes the parrot landed next to him on the piece of debris. With difficulty, the magician scribbled a note on a piece of paper that was in his pocket. Using a shoelace, he carefully tied the note to the parrot's leg.

“Fly to shore,” he commanded. But the parrot just sat silently, staring at the magician. This went on for several hours.

“Come on you stupid bird,” the exasperated magician finally said. “Why won't you do as I ask?”

At last the parrot spoke: “OK, I give up,” It said. “How did you make the ship disappear?”

Last week, the Michigan House Republicans unveiled what they called their plan to reform Medicaid. In reality, it represents the terms the federal government would have to meet to get the House GOP to pass Medicaid expansion.

President Barack Obama's administration wants states to expand Medicaid, which in turn will aid in the implementation of Obamacare.

The House Republican plan includes reforms to Medicaid such as co-pays, health savings accounts and a 48-month cap on coverage for able-bodied adults without children. It is worth noting that coverage for this group (able-bodied adults) is what the Medicaid expansion is primarily all about.

In addition, the plan includes statutory language that would prevent the expansion from happening if the federal government fails to agree to the reforms. The plan also includes statutory language that would undo the expansion if the federal government were to renege on any aspect of the deal.

As was the case with the parrot, various reactions to the House Republican plan show what each entity involved is focused on.

For GOP lawmakers, doing anything that appears to accommodate Obamacare is potentially a political poison pill. That’s because their conservative base sees Medicaid expansion as giving up the battle to force the federal government to repeal, or at least change, Obamacare.

This explains what conservatives are focused on. They object to the very existence of the plan. From their perspective it is a dangerous to even stick a toe in the Obamacare tent.

Meanwhile, much of the news media focused on the 48- month cap and the fact that expansion would provide Medicaid coverage to about 300,000 residents. This seems to have been a direct reflection of the reaction Democrats had to the plan. To the liberal mind the focus is on coverage. In fact, that was the impetus behind Obamacare.

This fixation on coverage is a consistent theme with American liberals. Never mind that studies have shown that, for able-bodies adults, Medicaid coverage has little advantage over no coverage at all. In fact, it can actually be worse than having no coverage.

Many liberals tend to take great comfort in having something on paper, even when its actual value might be little more than a mirage.

Another response to the House Republican plan within the news media was one of dismay. Some reporters were taken aback by the audacity of the Republicans for daring to put conditions on Medicaid expansion when the federal government is offering billions of dollars to the state.

The thought that there might be fishhooks buried in the tantalizing salmon never seems to enter their minds.

On the face of it, the House Republican plan is basically an offer that the Obama administration would almost surely refuse. The real question about the plan is whether it is essentially a creative statement of defiance to what's going on in Washington, D.C. If,  and only if, House Republicans stick to their guns and refuse to budge on the major points in the plan, that's what it will likely end up being.

(Editor’s Note: Jack Spencer is Capitol Affairs Specialist for Michigan Capitol Confidential. He is a veteran Lansing-based journalist. His columns do not represent viewpoints of the Mackinac Center for Public Policy or Michigan Capitol Confidential.)