Medicaid Expansion: A Battle Over Two Views

Historic opportunity to reform Washington, D.C.

Republicans in Michigan are divided on the question of how to react to Obamacare. They are currently in conflict over the issue of Medicaid expansion.

This is a classic example of the administrative perspective versus the historic perspective. Medicaid expansion is the top issue facing state lawmakers regarding Obamacare this year.

Last summer, when the U.S. Supreme Court ruled that Obamacare was constitutional, it also said the federal government could not force states to expand Medicaid.

However, expansion of Medicaid is a critical step in the implementation of Obamacare. It is so important that the Obama administration is offering hundreds of millions of dollars to states that are willing to expand the social welfare program.

As with so many offers like this from Washington, D.C., there are strings attached. Accepting the short-term dollars could potentially lead to states being on the hook for even larger amounts in the long run. This seems especially likely considering that the federal government is $17 trillion in debt.

Perhaps more significantly, if Michigan makes the expansion it would fall into the column of states cooperating with the implementation of Obamacare.

Gov. Rick Snyder wants Medicaid expansion. In essence his position is: “I don't like Obamacare either, but Obama won re-election. Now, this is being forced upon us. Let's find the best way to handle the situation.”

His approach is to do the expansion and get the federal dollars. Then he wants to pack away as much of the federal dollars as possible to help deal with whatever happens later. It is the plan of a creative administrator who has been confronted with a web of government rules and regulations.

Meanwhile, those who oppose the expansion are looking at a larger goal. What they see is the opportunity to either stop Obamacare or at least force the federal government to make basic changes to it.

In essence, there position is: “It's obvious that Obamacare is running into an array of implementation obstacles. Instead of letting the federal government impose changes here in Michigan, let's join other states in the attempt to force a change in Washington, D.C.”

This is a historic stance. If enough states hold out against Obamacare to thwart it or force major changes to it, that would be an event of historic magnitude. Imagine being a Republican lawmaker who could put “helping reverse or change Obamacare" on your resume. Imagine being able to have that as part of your political legacy.

However, allowing a measure of this magnitude to be passed with only a handful of Republicans voting yes is politically untenable in ways too numerous to count.

The most promising way to get GOP lawmakers to vote for Medicaid expansion would be to tell them they can have their cake and eat it, too. Devise legislation that would expand Medicaid, but theoretically allow the state to reverse the expansion later on.

The U.S. Supreme Court's ruling is silent about states reversing Medicaid expansion after they sign on.  Any premise that relies on state officials outwitting or out maneuvering the federal bureaucracy is no more than a pipe dream. If Michigan puts itself in the Obamacare column, that's where it will remain. At that point, the Obama administration would hold all the trumps and aces.

(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.)