Lawmakers, on a bipartisan 76-31 vote shortly before 10 p.m., approved expanding Medicaid eligibility in 2014 to 320,000 adults making up to 133 percent of the poverty line. Nearly a half-million Michiganders could enroll by 2021 under the federal health care law, according to estimates from Republican Gov. Rick Snyder, who supports providing the government-funded health insurance to more people.
"I believe it's time for us to stop playing defense with something that is the law of the land and begin to play offense," said Rep. Mike Shirkey, R-Clark Lake, who was a staunch opponent of Medicaid expansion before changing his mind. "This is a very unique opportunity for us to negotiate from a position of strength to get reforms in what have been long-held entitlement reforms, real reforms that will help people and help taxpayers."
The measure heads to the Senate, where passage could prove more difficult because the chamber is dominated by Republicans, 26-12, while GOP control of the House is narrower. Under legislative rules, the House had to vote this week if the Senate is to approve the bill before lawmakers break for the summer in a week.
Medicaid covers roughly one in five Michigan residents — mainly low-income children, pregnant women and the disabled along with some poorer working adults.
Under the federal health care overhaul, states can expand Medicaid to adults making up to 133 percent of the poverty level, or about $15,300 for an individual. The U.S. government is offering to cover the entire cost initially and 90 percent down the line.
The House bill includes GOP-written requirements that new enrollees pay some of their medical expenses after being on the program for six months and pick up more costs after getting Medicaid for four years. They could lower their costs by not smoking, for instance, or adhering to other healthy behaviors.
The newly eligible also would no longer be covered if savings from the expansion do not cover the state's costs in the future.
The federal government would have to sign off for Michigan to proceed with its plan.
Adults ages 21 to 64 and making between 100 and 133 percent of the poverty line would have two options after four years under the legislation: buy government-subsidized insurance through a new health insurance market or stay on Medicaid by paying more out-of-pocket costs.
The four-year provision would not apply to those earning under the poverty level.
Supporters contend that offering health insurance to more poor people will make them healthier and minimize their expensive trips to the emergency room, saving money throughout the health care system. The state would save $200 million a year initially because more people covered by state aid would be covered with federal Medicaid dollars.
Opponents say federal money still comes from taxpayers and question such as large government expansion when the U.S. is trillions of dollars in debt. A group of tea party and conservative activists said earlier this week that they would oppose Snyder's expected re-election bid because of his push to expand Medicaid coverage.
Expanding Medicaid eligibility could cut Michigan's uninsured by nearly half. Uninsured residents with higher incomes will be covered by a new federal insurance market offering taxpayer-subsidized private plans.
No legislators rose to speak against the bill before the vote. After is passed, Democrats erupted in applause.
"I'm proud that this Legislature for the first time in a long time — this goes for both sides — rejected the extremes that too often define who we are," said Rep. Brandon Dillon, D-Grand Rapids. "We haven't listened to the loudest voices but listened to the voice of people who are experts. ... This isn't just a philosophical argument about size and scope of government. This is a bill that will immediately impact people in a very positive way."
To read House Bill 4714, CLICK HERE.