On a 75 to 32 vote on Tuesday, the state House concurred with the Senate's version of House Bill 4714, which will expand Medicaid in Michigan. Now, Gov. Rick Snyder, who asked for the measure, can sign it into law.

Medicaid expansion was the key issue state lawmakers faced this year regarding the Patient Protection and Affordable Care Act, known as Obamacare. Getting states to do the expansion is a vital step toward implementing Obamacare. Michigan will be the 25th state to do so, while 21 states have refused.

Among Republican House members, 28 voted for the bill and 31 voted against it. Meanwhile, the Democrats supplied 47 of the “yes” votes. All but one of the Democrats voted “yes,”

Rep. Greg MacMaster, R-Kewadin, was the only House member to change his vote from the one he cast when an earlier version of the bill passed in the House on June 13. MacMaster voted “yes” in June but voted “no” on Tuesday. Rep. Gail Haines, R-Waterford, was absent when the June 13 vote was taken. She voted “yes” on Tuesday. The lone Democrat who voted “no,” was Rep. Scott Dianda, D-Calumet.

Including last week’s vote in the Senate, 49 Republican senators and representatives voted “no” on the final version of House Bill 4714, while 36 voted “yes.”

“Every Republican legislator – including ones who voted ‘no’ on the expansion – shares some of the responsibility for this,” said Jack McHugh, senior legislative analyst with the Mackinac Center for Public Policy. “Had they been willing to buck the Governor and raise a ruckus in their own caucuses, they could have prevented a Speaker and Majority Leader they themselves selected from using the votes of Democrats and a minority of Republicans to ‘roll’ their own caucuses.”

“They weren’t willing to do those things, which fully explains this vote,” McHugh added. “No Republican legislator can feel comfortable about a critical Obamacare implementation measure being adopted on his or her watch.”

There were no efforts to amend the legislation Tuesday and no real debate on the House floor. Only one legislator, Rep. Ed McBroom, R-Vulcan, spoke on the bill.

“We should all remember that Medicaid does not offer the best option of care for the expanded population,” McBroom said.” I've been on Medicaid and so have members of my family. It is not easy and it is not a great option. We seem to be focused on the overall numbers and overall dollars rather than the quality of care provided. This issue is coupled with the insipid insinuation that providing Medicaid to the expanded population will dramatically change the usage of emergency rooms for primary care. I think this is a ludicrous presumption.”

“Helping the most in need in our state is a good investment, whether it saves the state money or not,” McBroom continued. “The problem is; we only have so much to utilize for this. The feds only have so much to invest and one could argue, with their debt and deficits, they don't really have any at all. I believe we are pledging more than we can afford and am confident the federal government is pledging far, far in excess [of] what it can afford. The insolvency of Medicaid, long term, for the federal government is clearly apparent and will drag us down if we are attached to it. It will be hugely more expensive and expansive than is currently being discussed, which will further accelerate the insolvency.”

Michigan will now receive billions in “up-front” dollars from the Obama administration for making the expansion. The federal government has pledged to pay for the first three years. After that, the state will start bearing an increasingly larger share of the cost.

Proponents of House Bill 4714 claim the bill was crafted in a manner that would allow the state to undo the expansion in the future over issues of funding or the federal government’s refusal to allow reforms. Critics of the expansion argue that this is an unrealistic claim devised as a short-term cover story.

Because the bill failed to get enough votes in the Senate to give it “immediate effect,” Medicaid expansion in Michigan will begin April 1, 2014 instead of Jan. 1, 2014. 

"I would have preferred to have gotten immediate effect, but what I would say is this is still a victory for Michiganders — both in terms of the people getting coverage and all Michiganders," Gov. Snyder told reporters.

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See also:

Eight Senate Republicans Join Democrats In Passing Obamacare Medicaid Expansion

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'

'ER Visits Won't Increase' Claim By Medicaid Expansion Advocates Remains Dubious

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