Applause for GOP fix to Medicaid bill

Sometimes, when you’re convinced that a logical, pragmatic solution to a political problem is out of reach, a politician suddenly emerges as a leader who will do the right thing — the hard thing — in the face of opposition from his partisan pals.
That pol, this time around, is state Senate Majority Leader Randy Richardville, a Monroe Republican, who is on the verge of some delicate political maneuvering that will save the Michigan Medicaid expansion plan.

Six weeks ago, it appeared that Medicaid expansion, offered under Obamacare, was going to die a quiet death in this state as the GOP-dominated Senate seemed content to leave the Capitol for a long summer vacation, letting the issue fade away.
Republican Gov. Rick Snyder appropriately scolded the Senate, saying it was time for a vote, not a vacation. Democrats and liberal interest groups applied pressure, too.

In time, Richardville’s approach toward reviving the measure, creating a Senate study group while he walked a fine line between the governor and tea party groups, appears to have harvested success.
The bipartisan working group produced a commendable revised version of the House bill (which received GOP support), incorporating several reasonable reforms. At the same time, Richardville allowed tea party Republicans to offer ideologically pristine alternatives that, when the full Senate votes in late August, will likely serve as a strategic escape hatch for skittish senators, rather than a poison pill that kills the entire effort.

The main bill, approved 4-0 by a Senate committee vote, offers a number of conservative alterations to the House approach.
The biggest overhaul is a provision initiated by the House that requires new Medicaid recipients to pay 5 percent of out-of-pocket medical costs and, after 48 months, 7 percent. As an alternative, these long-term Medicaid recipients could go onto the state’s Obamacare exchange to shop for private insurance.
The legislation also provides a compassionate compromise, an exemption from the 48-month penalty for those who are frail or suffer from chronic diseases or mental health problems.
The main Senate bill also establishes: more flexibility for the state Department of Community Health to determine eligibility; incentives for healthy habits, such as not smoking and receiving an annual physical/evaluation; strong language ensuring the state never pays more than promised under the federal deal; and consequences for individuals who fail to contribute co-pays.

Health department director Jim Haveman, who has served in Republican and Democratic administrations, praised the Senate committee’s efforts, saying it allows for a Michigan-centric policy that creates an “incubator” for new ideas.
How reasonable are these changes? Well they managed to bring together the Small Business Association of Michigan, which called the bill “an obvious ‘yes,’” and a liberal group that serves as the voice of the state’s poor, the Michigan League for Public Policy, which called it “a huge step forward.”

At the same time that congressional Republicans engage in shameless attempts to derail Obamacare before it has taken full effect — such as a 40th vote to repeal the Affordable Care Act — the Lansing GOP has settled on a more rational approach.
It’s important to remember that most of the nearly 2 million Michigan residents receiving care under the current poverty-only version of Medicaid are nursing home-bound seniors, pregnant women, poor children, the disabled and the mentally ill.
The expansion of 470,000 recipients under Obamacare, making Medicaid coverage available to those living at up to 133 percent of the federal poverty level — a $26,500 annual income for a family of three — would save the state money by eliminating hyperexpensive visits to hospital emergency rooms by the uninsured “working poor” seeking basic health care.
The feds will pay 100 percent of the cost of this health care expansion through 2017 and will gradually reduce that reimbursement to 90 percent by 2020.

Richardville’s tightrope-walking depends on an affirmative Senate vote in late August, as promised, so the state will not fall hopelessly behind the curve in meeting all the requirements and timelines involved in offering expanded Medicaid on Jan. 1. The logistics deadlines are approaching quickly.
The majority leader’s compromise will allow votes on the two alternatives, which are little more than expensive, delusional methods of offering health care to those slightly above the poverty line without federal funding. How can legislators back a plan to create health savings accounts for the working class when these people would consider living paycheck-to-paycheck a step up in life?

Richardville’s strategy apparently calls for pacifying tea party-Republicans while granting political cover to those senators who fear being primaried in 2014 by the tea party. The votes on the Medicaid alternatives would give these lawmakers the opportunity to demonstrate they are in lockstep with the tea party groups.
But the final votes — a mix of Republicans and all of the Democratic senators — will likely line up behind the main bill.
After the committee vote, Senate Minority Leader Gretchen Whitmer, playing her role as the loyal Democratic opposition, spanked the Republicans one last time. The East Lansing Democrat mildly praised the main bill while chastising the GOP for waiting another four weeks for a final vote.

But if political maneuvering and politicians playing their scripted roles is what it takes to revive a major piece of legislation that will make a difference for decades, well, sometimes you need to mark a moment when our hyperpartisan system still functions.
Sometimes, you just need to sit back and enjoy a brief glimmer of a healthy democracy.