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2013 House Bill 4714: Accept federal health care law Medicaid expansion

Public Act 107 of 2013

  1. Introduced by Rep. Matt Lori (R) on May 9, 2013, to expand Medicaid eligibility to families and childless adults up to 138 percent of the federal poverty level, but make this contingent on the federal government allowing the state to implement specified Medicaid reforms. Under the federal health care law called Obamacare by most people, this expansion was originally mandatory for states, but the Supreme Court ruled it can only be optional for states. Under current provisions, the feds are supposed to pay 100 percent of the expansion’s cost during the first three years (not counting administration costs), with the state responsible for not more than 10 percent of the costs starting in 2020. Most of the more than $3 billion annually would go to hospitals in the form of managed care contracts with the state.
    As introduced, the reforms required by the bill appear to be “poison pill” ones the Obama administration would not approve. They include: A four year cap on Medicaid benefits for non-disabled adults; a requirement that non-disabled adult beneficiaries must contribute “up to” 5 percent of their income as deductibles, copays, etc.; allow Health Savings Accounts for non-disabled adult beneficiaries; allow non-disabled adults to choose a “contracted health plan” through the agency styled as the “exchange” (most Michigan Medicaid recipients are already enrolled in contracted managed-care plans, so without the other reforms this would not appear to represent a significant change in the status quo); allow the state to impose “healthy behavior incentives” on non-disabled adults; require the federal government to permanently assume 100 percent of the state’s expansion-related costs; and more. In addition, the Obama administration would have to approve these reforms before the expansion could begin.
    • Referred to the House Michigan Competitiveness Committee on May 9, 2013.
      • Reported in the House on June 12, 2013, with the recommendation that the substitute (H-3) be adopted and that the bill then pass.
    • Substitute offered in the House on June 13, 2013, to adopt a version of the bill that does not require federal approval-in-advance of certain cost-saving Medicaid reforms before the expansion can proceed, and which would require far less rigorous reforms than the original version. The substitute passed by voice vote in the House on June 13, 2013.
    • Amendment offered by Rep. Jim Townsend (D) on June 13, 2013, to not include veterans enrolled in the Medicaid expansion under a provision that would rescind the expansion if the federal government does not approve certain cost-saving reforms by the end of 2015. Note: The ability of the state to rescind the expansion is questioned by many legal experts, who note that the Supreme Court decision making the expansion optional for states did not authorize their exiting it once they have entered. The amendment failed by voice vote in the House on June 13, 2013.
    • Amendment offered by Rep. Mike Shirkey (R) on June 13, 2013, to insert deadlines for certain Department of Community Health tasks required under the bill. The amendment passed by voice vote in the House on June 13, 2013.
    • Amendment offered by Rep. Greg MacMaster (R) on June 13, 2013, to make explicit that this bill does not authorize the creation of a state version of the federal health care law's subsidy administration agency styled as the "exchange". The amendment failed by voice vote in the House on June 13, 2013.
    • Amendment offered by Rep. Mike Shirkey (R) on June 13, 2013, to require the Department of Community Health to include as many Medicaid beneficiaries as allowed under federal law in managed care organizations under contract with the state, rather than granting them "fee for service" benefits. The amendment passed by voice vote in the House on June 13, 2013.
    • Amendment offered by Rep. Paul D. Clemente (D) on June 13, 2013, to strip out a provision that would require Medicaid beneficiaries to enroll in a health insurance policy offered through the agency styled as the "exchange" after 48 months on the program, which may require them to pay more for their benefits. This 48 month provision would not go into effect unless the federal government grants permission through a "waiver". The amendment failed by voice vote in the House on June 13, 2013.
    • Amendment offered by Rep. Martin Howrylak (R) on June 13, 2013, to strip out the provision authorizing the Medicaid expansion. The amendment failed by voice vote in the House on June 13, 2013.
    • Amendment offered by Rep. Martin Howrylak (R) on June 13, 2013, to strip out one of the provisions enabling the Medicaid expansion. The amendment failed by voice vote in the House on June 13, 2013.
  2. Passed 76 to 31 in the House on June 13, 2013, to expand Medicaid eligibility to families and childless adults up to 138 percent of the federal poverty level, which implements a key component of the federal health care law (aka “Obamacare”). Under that law, the feds are supposed to pay 100 percent of the expansion’s cost during the first three years, with the state responsible for not more than 10 percent of the costs starting in 2020. This does not contain a provision in the original version of the bill requiring the federal government to approve certain cost-saving state Medicaid reforms before the expansion could proceed, and would also require far less rigorous reforms.
    Who Voted "Yes" and Who Voted "No"

  3. Received in the Senate on June 18, 2013.
    • Referred to the Senate on June 18, 2013.
    • Referred to the Senate Government Operations Committee on June 20, 2013.
      • Motion by Sen. Tupac Hunter (D) on July 3, 2013, to discharge the Committee on Government Operations from further consideration of the House-passed bill that would implement the Medicaid expansion component of the federal health care law (called "Obamacare" by most people), and bring the bill directly to the full Senate for consideration and possibly a vote. The motion failed 12 to 18 in the Senate on July 3, 2013.
        Who Voted "Yes" and Who Voted "No"

      • Reported in the Senate on July 31, 2013, the Senate "work group" version of the bill. This would require the federal government to approve a program of health savings accounts, modest cost-sharing, and “healthy behavior incentives” for Medicaid recipients before the expansion could proceed. (State Medicaid officials testified in committee this “waiver” would probably be granted before the expansion’s Jan. 1, 2014 starting date.) Recipients would be enrolled in HMO-like managed care plans provided by hospitals that are granted state contracts for this.
        The bill would also require the state to request federal permission to limit individuals covered by the expansion to 48 months on the program, and would supposedly terminate the benefits of some 400,000 individuals expected to be enrolled, and around $3 billion worth of federally-funded managed care contracts with hospitals, if permission was not granted by 2016.
    • Substitute offered in the Senate on August 27, 2013, to adopt a version of the bill that revises details of the conditions the federal government supposedly must meet for the Medicaid expansion to begin and to continue after 2015. Also, to revise the scope of certain price controls the bill would impose on hospitals. The substitute passed by voice vote in the Senate on August 27, 2013.
    • Amendment offered by Sen. Patrick Colbeck (R) on August 27, 2013, to use more rigorous methods for estimating cost savings that supposedly will be generated by changes in the state Medicaid program associated with its expansion under the federal health law. If savings are not realized then supposedly the state will tell the federal government to stop funding some $3 billion in increased annual managed care contracts with Michigan hospitals under the expansion. Specifically, the amendment would require supposed "savings" in medical welfare costs to be measured in terms of whether actual spending goes up or down, rather than with metrics that depend on figures reported by hospitals. The amendment failed 17 to 21 in the Senate on August 27, 2013.
      Who Voted "Yes" and Who Voted "No"

  4. Failed 19 to 18 in the Senate on August 27, 2013, to expand Medicaid eligibility to families and childless adults up to 138 percent of the federal poverty level, which implements a key component of the federal health care law (aka “Obamacare”). Under that law, the feds are supposed to pay 100 percent of the expansion’s cost during the first three years, with the state responsible for not more than 10 percent of the costs starting in 2020.
    Who Voted "Yes" and Who Voted "No"

  5. Motion by Sen. Arlan Meekhof (R) on August 27, 2013, to reconsider the vote by which the bill was defeated. The motion passed by voice vote in the Senate on August 27, 2013.
  6. Received in the Senate on August 27, 2013.
    • Amendment offered by Sen. Tom Casperson (R) on August 27, 2013, to extend certain price controls the bill would impose on hospitals to patients with income up to 250 percent of the federal poverty level (FPL) rather than 133 percent. The amendment passed by voice vote in the Senate on August 27, 2013.
  7. Passed 20 to 18 in the Senate on August 27, 2013, to expand Medicaid eligibility to families and childless adults up to 138 percent of the federal poverty level, which implements a key component of the federal health care law (aka “Obamacare”). Under that law, the feds are supposed to pay 100 percent of the expansion’s cost during the first three years, with the state responsible for not more than 10 percent of the costs starting in 2020.
    Who Voted "Yes" and Who Voted "No"

  8. Motion in the Senate on August 27, 2013, to give the bill immediate effect. Without a two-thirds majority on this vote, the Medicaid expansion cannot proceed until 90 days after the 2013 legislative session concludes at the end of the year. Under the federal health care law, the expansion is scheduled to begin on Jan. 1, 2014. The motion failed 24 to 14 in the Senate on August 27, 2013.
    Who Voted "Yes" and Who Voted "No"

  9. Received in the House on September 3, 2013.
  10. Passed 75 to 32 in the House on September 3, 2013, to concur with the comparatively minor changes the Senate made to the House-passed bill. This vote send the measure to the Governor for signature.
    Who Voted "Yes" and Who Voted "No"

  11. Signed by Gov. Rick Snyder on September 16, 2013.

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