Expansion of Medicaid in Arizona, Michigan shows how Democrats, Republicans can work together.
olks, there is reason to be hopeful that our lawmakers can put aside their ideological differences every now and then and do what makes sense for constituents.
In fact, last week some of the people we have elected to represent us — at least at the state level — even showed a willingness to put careers at risk by doing what they believe is the right thing.
One of the most contentious issues during state legislative sessions this year has been whether to expand the Medicaid program for low-income individuals and families, as Congress intended when it enacted health care reform three years ago.
The state-level debate was made necessary when the Supreme Court ruled last year that Congress can’t force the states to expand their Medicaid programs, even if the feds will always cover no less than 90 percent of the cost. Medicaid is jointly funded by the states and the federal government.
All of the states in which Democrats control both the governor’s office and legislature were quick to notify the Obama administration that they would take the federal money and expand their Medicaid programs to include families with incomes up to 138 percent of the federal poverty level. But that has not been the case in many of the states where Republicans enjoy a majority in one or both legislative chambers or have a Republican governor.
To date, 20 of those states have said “no thanks” — at least for now. The debate is still going on in seven others. But 23 states and the District of Columbia, including a number of red or purple states, have agreed to move forward with expansion next January.
Advocates of both health care reform and bipartisanship had reason to cheer last Thursday when lawmakers in conservative Arizona passed and sent to GOP Gov. Jan Brewer a Medicaid expansion bill she had endorsed. It would not have passed had several Republicans in both the House and Senate not joined Democrats in supporting the bill during a special session of the legislature.
The other good news Thursday came from Michigan, when after nine hours of debate, the GOP-controlled House approved, on a bipartisan vote of 76-31, a bill supported by Democratic Gov. Rick Snyder to expand Medicaid there.
I learned about it within minutes of the vote, thanks to Twitter. “Medicaid expansion passed!” tweeted Democratic Rep. Rashida Tlaib. “So proud of both my Democratic and Republican colleagues today.”
One legislator, Democrat Brandon Dillon, went so far as to say that Thursday was the first day he’d been proud to be a state rep.
And this from Republican House Speaker Jase Bolger: “This is a great example of cooperation in Lansing leading to the resolution of a difficult issue in a way that keeps the focus on the people of Michigan and what they need.”
It clearly took time for Republicans in both Arizona and Michigan to come around to supporting any part of the federal reform law they have criticized from the beginning.
While many Democrats hold the belief that “health care is a human right,” Republicans had to be persuaded that expansion makes sense from an economic point of view.
Crain’s Detroit Business quoted Republican Mike Shirkey as saying he was a “hard no” initially because of his general opposition to “Obamacare” but that he came around to support the expansion bill after weighing the pros and cons.
“There are perfectly good, legitimate, philosophical reasons to oppose, but a sincere effort to analyze the other sound, definable and measureable reasons to support outweighed those,” he said.
Among those measurable reasons: when more poor people have coverage, hospitals will have less “uncompensated care,” a misnomer because hospitals charge paying customers — and their insurers — substantially more just to cover the cost of care they provide to people who don’t have the means to pay.
Another compelling reason why many Republican lawmakers ultimately supported expansion is that if they didn’t, the federal taxes paid by state residents toward expansion would go to places that did enlarge their Medicaid programs.
As the Arizona bill was on its way to Brewer, she said in a statement that “it will extend cost-effective care to Arizona’s working poor using the very tax dollars our citizens already pay to the federal government.”
It may take a while, maybe even a few years, but I’m betting that lawmakers in the states that are saying “no thanks” now — even “hell no” — will eventually come around, despite what surely will be continued opposition from the Tea Party wing of the GOP. They will figure out at some point that it makes no sense for their fellow Floridians or Texans, for example, to be paying with their taxes for the coverage of folks in Arizona and Michigan.
Wendell is a Senior Analyst at The Center for Public Integrity where this first appeared on 6/17/2013.