2013 House Bill 4714 / Public Act 107

Accept federal health care law Medicaid expansion

Introduced in the House

May 9, 2013

Introduced by Rep. Matt Lori (R-59)

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.<br> 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 Committee on Michigan Competitiveness

June 12, 2013

Reported without amendment

With the recommendation that the substitute (H-3) be adopted and that the bill then pass.

June 13, 2013

Substitute offered

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

Amendment offered by Rep. Jim Townsend (D-26)

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

Amendment offered by Rep. Mike Shirkey (R-65)

To insert deadlines for certain Department of Community Health tasks required under the bill.

The amendment passed by voice vote

Amendment offered by Rep. Greg MacMaster (R-105)

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

Amendment offered by Rep. Mike Shirkey (R-65)

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

Amendment offered by Rep. Paul Clemente (D-14)

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

Amendment offered by Rep. Martin Howrylak (R-41)

To strip out the provision authorizing the Medicaid expansion.

The amendment failed by voice vote

Amendment offered by Rep. Martin Howrylak (R-41)

To strip out one of the provisions enabling the Medicaid expansion.

The amendment failed by voice vote

Passed in the House 76 to 31 (details)

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.

Received in the Senate

June 18, 2013

Referred to the Committee of the Whole

June 20, 2013

Referred to the Committee on Government Operations

July 3, 2013

Motion by Sen. Tupac Hunter (D-5)

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 (details)

July 31, 2013

Reported without amendment

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.<br> 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.

Aug. 27, 2013

Substitute offered

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

Amendment offered by Sen. Patrick Colbeck (R-7)

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 (details)

Failed in the Senate 19 to 18 (details)

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.

Motion by Sen. Arlan Meekhof (R-30)

To reconsider the vote by which the bill was defeated.

The motion passed by voice vote

Received

Amendment offered by Sen. Tom Casperson (R-38)

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

Passed in the Senate 20 to 18 (details)

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.

Motion

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 (details)

Received in the House

Sept. 3, 2013

Passed in the House 75 to 32 (details)

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.

Signed by Gov. Rick Snyder

Sept. 16, 2013