Republican Ploy to Stop Medicaid Expansion?

Obamacare Capitulation at a Discount Price

This week Michigan Capitol Confidential reported a committee vote to adopt a substitute version of House Bill 4714, the Obamacare Medicaid expansion. The next day some of the Republicans named in that report voted against advancing this bill to the full House. These expansion opponents were Reps. Kevin Cotter, Ken Goike, Ray Franz, Tom Leonard and Dan Lauwers. While these legislators missed the chance to place a "speed bump" in front of Obamacare capitulation, on the more important committee action they voted against accepting the Medicaid expansion.

At the time the members of that committee may not have realized it, but the vote we reported did appear to be a key moment. This was consideration of the original bill with its waiver-in-advance-for-concrete-reforms officially ceased. Instead, consideration turned to "waiver-later-for- less-concrete-reforms," with "opt-out" contingencies so implausible as to appear a mere cover story for capitulation.

The vote was also worth reporting because it was House Republicans who made a big deal about the steep price in reforms they were demanding for Michigan's collaboration with Obamacare. But suddenly, this committee was offering surrender at a fire-sale price.

For context, right now it appears 19 states are saying no and six are leaning against Medicaid expansion — fully half the states in the union.

In addition, leaving aside the legality of a potential state “opt-out” from the expansion sometime down the road, and proposed statutory provisions related to that, and the political realities of halting future benefit checks once they have begun to flow, everyone in Lansing knows how this game is played: The federal expansion money will start rolling in, and in May 2018, under  an entrenched Obamacare, the supposed “savings” this legislation generates from its weak reforms won't be enough to make up for a programmed fall off in a 100 percent federal funding commitment. This will happen even though the bill appears to contain some razzle-dazzle, hospital-friendly, "indirect job" type provisions.

Everyone will be shocked — shocked! — and the appropriations committee chairs will ask their colleagues, "Are we going to leave nine federal Medicaid dollars on the table for an investment of just one state dollar?" Of course they won't.  In every possible way, the expansion is a “roach motel” — once we go in we’re not getting out.

Mackinac Center analysts have been clear — we don’t think any reforms are worth the price of entrenching Obamacare as long as resistance may still pay off in terms far more meaningful than marginal changes to a welfare entitlement program. Plus, under an entrenched Obamacare regime, "reform" is probably an oxymoron.

Yet I fear that legislative Republicans have lost sight of the stakes in this contest. Some of my Mackinac Center colleagues and friends are saying it must be part of a clever scheme to avoid capitulation, because those legislators can't really mean it.