Medicaid expansion has passed Michigan’s Republican-controlled legislature, expanding insurance coverage to 400,000 low-wage earners in Michigan. It required some cajoling and arm-twisting, but Gov. Snyder is ultimately in control of the state Republican Party and he was able to convince around half of the GOP caucus to act in the interests of the state rather than cower in fear from Tea Party challengers in their gerrymandered districts.
That is apparently not the case in Ohio.
Compared to Ohio, the Michigan GOP has a smaller House majority but a larger Senate majority. Nevertheless, 25 of 59 GOP House members and 8 of 20 GOP senators voted in favor of expanding insurance coverage at no cost to the state.
In Ohio, the state would save money by expanding Medicaid, since Managed Care plans are subject to the state sales tax.
UPDATE: Wonkblog reports that a last-minute amendment requires enrollees to pay 7% of their income if they’ve been enrolled for 4 years. That’s not going to fly with HHS, because Exchange insurance would only cost 3.35% of their income.
It’s an amendment to make Medicaid more expensive than private insurance. That’s a no-go.
Since Michigan will expand in March 2014 and the waiver won’t be approved or denied until 2015, it seems likely that the expansion will stay in place after the waiver is denied.
I imagine that the Ohio GOP will push for this amendment. If expansion is contingent on HHS approval of this waiver then it won’t actually be expansion, because HHS isn’t going to let states charge Medicaid enrollees more than they charge Exchange purchasers.