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Michigan May Soon Join Arizona in the Medicaid Expansion Column

By John Reichard, CQ HealthBeat Editor

June 14, 2013 -- Michigan may soon be joining Arizona as a state where a Republican governor overcomes opposition from within the GOP to move legislation through the state legislature to expand Medicaid under the health care law.

The Michigan House voted late last week to approve the expansion by an unexpectedly lopsided margin of 76 to 31. Previously, Arizona state lawmakers buckled under pressure from Republican Gov. Jan Brewer to pass an expansion measure in that state.

Michigan Gov. Rick Snyder has warned lawmakers in this state that Medicaid expansion must be cleared by the state's senate by June 21 if it is to start on Jan. 1. That's because the measure will entail getting waivers from the Centers for Medicare and Medicaid Services for some of its provisions.

The Michigan Legislature is scheduled to wind up its session at the end of next week.

The wide margin of victory in the Michigan House helps to create momentum for passage in the state Senate, said a lobbyist for Michigan hospitals. Snyder, the House speaker, and the Senate majority leader in the state legislature are all cautiously optimistic that the Senate will be able to wrap up the job by the end of next week. But there is much work to be done, cautioned the lobbyist, David Finkbeiner, senior vice president for advocacy with the Michigan Health and Hospital Association.

"Michigan's legislature is controlled by Republicans, as is the governor's office," he said. "There were questions about whether or not there would be, in conjunction with Democrats, enough Republican votes, and it turned out to be more than enough" in the House.

But in the Senate, "they're interested in their own review," Finkbeiner said.

Finkbeiner said Snyder was able to bring Republicans on board in the House through efforts to craft a "Michigan-specific" approach to Medicaid. Under that approach, people in the program would have "more skin in the game," he said. It includes a provision that after four years on Medicaid, able-bodied adults would have a choice of moving to an insurance exchange to sign up for coverage or pay a higher level of out-of-pocket payments to stay on Medicaid.

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