Michigan GOP governor proposes Medicaid expansion

Snyder said Medicaid expansion would save the state $200 million a year initially because more people who now receive mental health services and medical care from state-funded programs would instead be covered with federal money. He called for setting aside $100 million a year of those savings so Michigan can pay 10 percent of the cost for new enrollees down the line. He said the expansion would effectively cost Michigan nothing until 2035.

This is the second time in less than 18 months that Snyder has bucked some in his own party on the Affordable Care Act.

His call to implement a state-run online marketplace where the uninsured can get taxpayer-subsidized private coverage died in the GOP-led House. Michigan now is on the path toward a partnership exchange controlled primarily by the federal government.

By expanding Medicaid in 2014, Michigan could next year add about 320,000 people to a program that already serves about one in five state residents. About 470,000 people would be added longer term.

Three years of full federal funding for newly eligible enrollees — roughly $2 billion a year — is available from 2014 through 2016, gradually phasing down to 90 percent in 2020 and after. The match rate for existing Medicaid participants is 66 percent.

To qualify, annual household income must be below 138 percent of the federal poverty level, about $15,000 for an individual and $32,000 for a family of four.

Conservatives are concerned deficit-burdened Washington will renege on the 90-percent deal and also have a philosophical resistance to expanding government programs and the notion that federal dollars are different from state dollars.

At least one business organization is supporting Snyder. The Small Business Association of Michigan echoed his concerns with the uninsured not getting preventive treatment and later going to the emergency room for more expensive medical care that is passed onto people and companies with private insurance coverage.

"It's called cost-shifting and it's been happening for a very long time," said Rob Fowler, the group's president and CEO. "Whether you supported Obamacare or not — and we did not — one of the main elements of it is 'everybody in.'"

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