DEARBORN, MI -- Michigan Republican Gov. Rick Snyder signed historic Medicaid expansion legislation into law in the same way the Legislature passed it: With bipartisan support.
Snyder was flanked by Democratic U.S. Rep. John Dingell, who authored part of the Affordable Care Act, as he put his pen to a plan designed to reform Medicaid and expand eligibility to nearly a half million people using federal funding available under the controversial law.
"This is about the health of fellow Michiganders," Snyder said during a press conference at Oakwood Health Center in Dearborn. "The right answer is not to talk about politics, but to talk about our family of 10 million people."
Dingell, who visited Lansing in June and urged state lawmakers to approve the Medicaid legislation, congratulated Snyder on the accomplishment and made a spirited pitch for bipartisan cooperation beyond the stage he stood on.
"For the sweet love of God, let's understand that we have to work together to make our government work," he said to applause. "Politics is a sport to many Americans, but it should not be a blood sport. We are all in this together."
With Snyder's signature, Michigan became just the third state led by both a Republican governor and Legislature to move forward with Medicaid expansion under the Affordable Care Act.
Snyder spent months lobbying members of his own party, and while a small majority of Republicans ended up voting against the measure, it passed through both the House and Senate with broad support from Democrats.
All told, 24 states and the District of Columbia are currently expected to expand eligibility beginning next year, according to a recent tally by the Kaiser Family Foundation.
Michigan's expansion is likely to happen later than most, however, because Republicans in the Senate denied the measure immediate effect -- meaning implementation cannot begin until late March or April.
"The easy part was getting the bill passed. The hard part is now in execution," said state Rep. Mike Shirkey, R-Clark Lake, a conservative lawmaker who ended up backing Medicaid expansion after working to add unique reforms to the legislation.
The "Healthy Michigan" plan, as the governor calls it, will require many new Medicaid recipients to pay income-based premiums that can be reduced through healthy lifestyle choices or increased if they choose to stay on Medicaid for more than four years.
The reforms will require two waivers from the Obama administration -- one up front and another a few years from now. Michigan could still "opt out" of the expansion if the federal government denies either waiver or if long-term costs exceed early year general fund savings, which the Senate Fiscal Agency expects will happen in 2027-28.
If Michigan wins federal waivers, it will be able to access more than a billion dollars a year in federal funding as it expands Medicaid coverage to individuals earning up to 133 percent of the poverty level. That's around $15,000 for an individual or $31,000 for a family of four.
The federal government is expected to cover the full cost of Medicaid expansion for three years before gradually reducing funding to 90 percent by 2021.
The Snyder administration estimates the expansion eventually will cover up to 470,000 new residents, allowing them to access primary care rather than seek expensive treatment at an emergency room.
Because the expanded Medicaid eligibility will cover some mental health services the state is currently paying for, Michigan stands to save roughly $200 million a year in general fund spending in initial years.