JACK SPENCER: Medicaid expansion, a battle over two views
Republicans in Michigan are divided on the question of how to react to Obamacare. They are currently in conflict over the issue of Medicaid expansion. This is a classic example of the administrative perspective versus the historic perspective.
Medicaid expansion is the top issue facing state lawmakers regarding Obamacare this year. It is currently the “huge” issue in the Michigan legislature. All the other issues seem small by comparison.
Last summer, when the U.S. Supreme Court ruled that Obamacare was constitutional, it also said the federal government could not force states to expand Medicaid.
Expansion of Medicaid is a crucial step in the implementation of Obamacare. It is so important that the administration of Barack Obama is offering hundreds of millions of dollars to states that are willing to make the expansion.
As with so many offers like this from Washington, D.C., there are strings attached. Accepting the short-term dollars could potentially lead to states being on the hook for even larger amounts in the long run. This seems especially likely considering that the federal government is $17 trillion in debt.
Perhaps more significantly, if Michigan makes the expansion it would fall into the column of states cooperating with the implementation of Obamacare. If Michigan refuses, it would fall into the column of states not cooperating.
Gov. Rick Snyder wants Medicaid expansion. In essence his position is: “I don't like Obamacare either, but Obama won re-election. Now, this is being forced upon us. Let's find the best way to handle the situation”
His approach is to do the expansion and get the federal dollars. Then he wants to pack away as much of the federal dollars as possible to help deal with whatever happens later. It is the plan of a creative administrator who has been confronted with a web of government rules and regulations.
Essentially, Snyder sees the situation as one in which the cards have been dealt and his job is to play them as skillfully as possible.
Meanwhile, those who oppose the expansion are looking at a larger goal. They want to stay out of the Obamacare game unless and until the cards get reshuffled. What they see is the opportunity to either stop Obamacare or at least force the federal government to make basic changes to it.
In essence, there position is: “It's obvious that Obamacare is running into an array of implementation obstacles. Instead of letting the federal government impose changes here in Michigan, let's join other states in the attempt to force a change in Washington, D.C.”
This is a historic stance. If enough states hold-out against Obamacare to thwart it or force major changes to it; that would be an event of historic magnitude. Think of what that would mean. Imagine being a Republican lawmaker who could put “helping reverse or change Obamacare” on your resume. Imagine being able to have that as part of your political legacy.
It's apparent that most of Michigan's GOP lawmakers currently oppose Medicaid expansion. What's also apparent is that there are enough Democrats in the state House to join with a handful of Republicans to pass the expansion. A similar situation may exist in the Senate as well.
However, allowing a measure of this magnitude to be passed with only handful of Republicans voting yes, is politically untenable in ways too numerous to count.
Let's make one thing clear. What we're referring to in this article is real Medicaid expansion, not the current GOP House plan, which, if it stays intact, would almost surely be rejected by the Obama administration.
With this in mind, the Snyder administration's goals are currently twofold:
First, to change the existing bill into something that the federal government can accept.
Second, to somehow get more than just a handful of Republicans to vote for it.
The most promising way to get GOP lawmakers to vote for Medicaid expansion would be to tell them they can have their cake and eat it, too. Devise legislation that would expand Medicaid, but theoretically allow the state to reverse the expansion later on.
Add to this the tempting prospect of getting a special deal from the Obama administration. It seems likely that lawmakers are being told that: “Yes, the feds are struggling to implement Obamacare. We're in a great position to take advantage of that. If we just agree to the expansion, we're in a position to get preferential treatment.”
This argument would give some cynical Republicans a tale to tell the voters in their districts. They could say:
“We won the tussle with the federal government, and if they don't come through, we put a clause in the bill that lets us get out of Obamacare later.”
For the less cynical, it could still be a temptation to go along with such a measure. Humans often tend to believe what they want to believe. It is not difficult to envision some lawmakers rationalizing that this sort of deal would actually leave Michigan with an escape hatch.
In reality, such an idea is just a tantalizing mirage.
The U.S. Supreme Court's ruling is silent about states reversing Medicaid expansion after they sign on. Any premise that relies on state officials outwitting or out maneuvering the federal bureaucracy is no more than a pipe dream. If Michigan puts itself in the Obamacare column, that's where it will remain. At that point, the Obama administration would hold all the trumps and aces.
Jack Spencer is Capitol Affairs Specialist for Capitol Confidential, an online newsletter associated with the Mackinac Center for Public Policy (MCPP). MCPP provides policy analysis. The political analysis represented in this column does not necessarily reflect the views of the Mackinac Center.