August 2, 2013, MichiganVotes.org Weekly Vote Report

The House and Senate remain in the midst of a summer break, but this week a Senate committee advanced four bills related to the federal health care law's Medicaid expansion to the full Senate.

The main one is a Senate version of House Bill 4714, passed by the House in June (Who Voted "Yes" and Who Voted "No"). This would authorize the Medicaid expansion in Michigan.

The other bills are alternatives to the expansion offered by two Republican Senators. They were advanced to the full Senate as potential options if Senators do not choose to adopt the expansion. Senate Majority Leader Randy Richardville, R-Monroe, has stated his intention to vote on the expansion during the last week of August.

Note that the Legislature is not required to pass any bill on this matter, making the primary alternative "do nothing." This is because the U.S. Supreme Court invalidated a mandate in the original Obamacare law that would have compelled states to expand this health welfare program.

House Bill 4714, "S-7" version: Accept federal health care law Medicaid expansion
The Senate work group version of a House passed bill to expand Medicaid eligibility to families and childless adults up to 138 percent of the federal poverty level, which implements a major component of the federal health care law (Obamacare). Under that law, the feds are supposed to pay 100 percent of the expansion's cost during the first three years, with the state responsible for not more than 10 percent of the costs starting in 2020.

This version of the expansion would require the federal government to approve a program of health savings accounts, modest cost-sharing, and "healthy behavior incentives" for Medicaid recipients before the managed care contracts could begin distributing benefits.

State Medicaid officials testified in committee this waiver would probably be granted before the expansion’s Jan. 1, 2014, starting date. Recipients would be enrolled in HMO-like managed care plans provided by hospitals granted state contracts for this.

The bill also would require the state to request federal permission to limit individuals covered by the expansion to 48 months of full benefits, and if permission was not granted by 2016, would supposedly withdraw the benefits of some 400,000 individuals expected to be enrolled, and around $3 billion worth of federally funded state managed care contracts with hospitals.

Reported from committee, pending before full Senate.

Senate Bill 422: Alternative to federal health care law Medicaid expansion
Introduced by Sen. Bruce Caswell, R-Hillsdale, to create a new state medical welfare program that for a minimal monthly premium ($5 to $20) would provide insurance benefits to individuals below the federal poverty level who are not eligible for federal Medicaid subsidies (which mostly applies to childless adults).

Reported from committee, available for consideration by the full Senate.

Senate Bill 459 and Senate Bill 460: Alternative to federal health care law Medicaid expansion (and more)
Introduced by Sen. Patrick Colbeck, R-Canton Township, to revise state insurance regulations to facilitate "direct primary care" arrangements, which are authorized as an option under the individual insurance mandate of the federal health care law. The bill would also authorize the use of private health insurance exchanges as an alternative to the government version of these entities, which are the vehicle by which the federal law administers and distributes insurance subsidies to individuals. (Note: The Federal government has reportedly agreed to use the private eHealthInsurance.com company to perform this role by giving it access to the federal exchange data hub.)

Direct primary care is a new-old health care delivery model that uses contracts between individuals and a physician in which routine and preventative health care services are delivered for a low monthly fee payment. This reportedly saves money because it eliminates the costly administration of reimbursements from conventional third-party insurance companies.

Senate Bill 460 would convert the Medicaid health welfare program into a system that combines direct primary care services, a high-deductible insurance plan, and gap insurance or deductible support subsidies to cover the high deductibles for low income persons.

Both bills were reported from committee, and are available for consideration by the full Senate.

SOURCE: MichiganVotes.org, a free, non-partisan website created by the Mackinac Center for Public Policy, providing concise, non-partisan, plain-English descriptions of every bill and vote in the Michigan House and Senate. Please visit https://www.michiganvotes.org

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