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Michigan: Medicaid expansion at risk for up to 600K

This is the first post I've written since Friday, partly because I had my kid's Lego® Robotics League event all day Saturday, partly because I came down with a 24-hour (I hope) flu yesterday.

Anyway, some not-so-cheery news to report today:

MICHIGAN WAIVER PUTS CMS IN TOUGH SPOT — The federal waiver Michigan needs to extend its Medicaid expansion has put CMS in a bind — either approve controversial conditions or let the program end next spring. Pro’s Rachana Pradhan writes, “The 2013 Michigan law expanding Medicaid included a provision requiring CMS to approve a waiver with drastically conservative changes by the end of this year. The waiver would require Medicaid enrollees earning above the poverty line to make a choice after four years of Medicaid coverage: Either enroll in a private subsidized plan on HealthCare.gov, or stay in Medicaid and pay up to 7 percent of household income toward health care costs — notably higher than the 5 percent ceiling CMS has held other states to.” If the waiver isn't approved, Medicaid expansion coverage is scheduled to end in April.

I don't have a Politico Pro account, so I don't know any additional details, but it sounds like the entire Medicaid expansion program in Michigan will have the plug pulled next spring if CMS doesn't approve the waiver. We're talking about roughly 600,000 people here, so this is indeed a pretty big deal.

As for the 7% provision itself, that seems pretty unreasonable and defeats the whole point of Medicaid in the first place. The federal poverty line for a family of 3 in Michigan is $20,090. The expansion provision covers people up to 138% FPL, which would be $27,724 for a family of 3. 7% of that is $1,941, or $162/month, which is a hell of a lot of money for a family only making $27K/year (and remember, the 7% rule would hold for anyone making 101% - 138%).

Frankly, this is why I'm not so sure that allowing the states to have "alternate" versions of Medicaid expansion was such a good idea in the first place. Not only do these "more conservative-friendly" Medicaid programs simply complicate things further (remember, part of the point of ACA Medicaid expansion was to simplify the program), but they also put the burden of "blame" for not having the programs approved on the federal government instead of on the states which are actually responsible. All any GOP-run state has to do is submit an absurdly draconian "waiver" request; CMS denies it, and suddenly they're the ones being blamed for "denying" hundreds of thousands of poor people healthcare coverage.

This is also a reminder--just like the recent Kentucky gubernatorial election results were--that many provisions of the ACA are still very fragile and can easily be reversed. Some states set up Medicaid expansion or their own ACA exchanges via executive order by the governor; others did so via legislative action. All of these things could be torn away in the future depending on who wins at the state level in the 2016 election (and beyond).

Elections matter.