Medicaid Expansion Bill may be a Bait-and-Switch

May 14, 2013

May 13, 2013

Dear Lawmaker:

On behalf of the more than 88,000 activists of Americans for Prosperity-Michigan, I am writing in opposition to House Bill 4714, which would expand Medicaid under President Obama’s Patient Protection and Affordable Care Act (PPACA). Click Here to Tell Your Lawmaker to Oppose Medicaid Expansion.

The reforms to Medicaid proposed in HB 4714 may be well intentioned, but please do not be fooled. This legislation still represents a huge and costly expansion of a failed government health insurance system over which the State of Michigan has very little control.

Yes, HB 4714 contains some attractive window-dressing, but the view for taxpayers has not changed. The conservative reforms proposed in this bill can too easily be stripped away through amendments on the House or Senate floor, in Conference Committee changes, via legislation passed by future policymakers, or by the Obama Administration. Michigan taxpayers will then be left with an expensive, unreformed government health insurance program that largely fails to improve health outcomes for its beneficiaries.

It bears noting that any reforms to Michigan’s Medicaid program that do not fall within federal program rules would require a waiver, provided to states at the sole discretion of the federal Department of Health and Human Services. HHS Secretary Kathleen Sebelius has not shown willingness to offer a waiver for any type of substantive changes to Medicaid implementation.

HHS is also not offering Medicaid waivers past December 2016, when the PPACA-created State Innovation Waiver program begins. This means that any waiver offered to Michigan, even a conditional one, can be yanked back by the federal government within just a few years during the last year of the Obama Administration. Again, don’t be fooled. Provisions contained in HB 4714 that would “sunset” expanded Medicaid coverage are politically unrealistic. States don’t scale back expansions.

The unlikelihood that meaningful Medicaid reform would be allowed by the Obama Administration raises questions as to the true intent of this legislation. Lawmakers who believe they can “poison the well” for Medicaid expansion by supporting this bill may too late discover that HB 4714 is a bait-and-switch. There are numerous opportunities for the conservative reforms contained in this bill to be watered down. Your vote will then have facilitated Medicaid expansion that will cost Michigan taxpayers $1.3 billion by 2022.

I urge you to be wary of this understandable, but ultimately misguided, attempt to make the best out of a bad program. Please see HB 4714 for what it is—a possible bait-and-switch aimed at garnering your support for President Obama’s Medicaid expansion. If state legislators want to demonstrate that they are serious about Medicaid reform, they should pass a resolution calling upon HHS to give Michigan a block grant for existing Medicaid dollars expended.


Scott Hagerstrom
State Director
Americans for Prosperity-Michigan

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