LANSING — Gov. Rick Snyder's failure to persuade the GOP-led Senate to offer medical insurance to low-income adults lays bare the fundamental difference between his approach to the contentious federal health care law and that of many of his fellow Republicans.
He doesn't believe the Affordable Care Act is the "right answer" but also sees the chance to help out working poor visiting emergency rooms for uncompensated care, the costs of which are borne by hospitals and ultimately everyone with health insurance premiums.
When House Republicans inserted provisions to make recipients pay some of their medical costs and incentivize them to be healthier – a plan dubbed "Healthy Michigan" – Snyder welcomed it as a pragmatic, proactive way to take a flawed law he thinks is here to stay and make it good for the state. Otherwise, he said, Michigan will pay $1.5 billion in taxes under the federal health overhaul and get nothing back, and hospitals will see lower Medicare and Medicaid reimbursements and receive nothing in return.
On the other side are detractors who contend Michigan can't make lemonade out of a rotten lemon.
"Most Republicans are not in favor of expanding Medicaid or doing anything to enable Obamacare. It's one of the worst policy decisions ever made in our federal government and frankly it's something that needs to be repealed as quickly as possible," said Sen. Patrick Colbeck, R-Canton Township.
He's among 26 Republicans in the Senate, where a longstanding GOP majority became a supermajority after the 2010 election – when Republicans were propelled to complete control of state government in part because of tea party angst over the health care law, bank rescues and stimulus spending. Yet Michigan voters also elected Snyder, a more moderate Republican whose embrace of parts of the Affordable Care Act has left him out of favor with the right wing of the party despite signing a right-to-work law in December.
President Barack Obama, whose name forever will be associated with the health care law, won re-election by 9 percentage points here in 2012.
Conservative activists and Americans for Prosperity-Michigan are credited in part with successfully pressuring the Senate to block Medicaid expansion, following Republicans' earlier decisions not to pursue another key component of the health care overhaul – an insurance marketplace where workers above the poverty line without health coverage can buy insurance with the help of tax credits. The federal government will run the exchange entirely much to Snyder's displeasure.
It's not insignificant that 31 of 38 senators, including 22 Republicans, can run for re-election in 2014.
The decision by Senate Majority Leader Randy Richardville, R-Monroe, to adjourn for two months without voting Thursday is bringing attention to unwritten rules regarding legislative procedure.
Richardville insisted that at least half the caucus, 13 Republicans, back Medicaid expansion or at least support proceeding with a vote. Expansion advocates believe if a vote had been called, eight to 11 Republicans would have joined 12 Democrats to send a measure to Snyder's desk.
Snyder said the rule shouldn't be applied in every case, and Democrats note bills have passed with just eight GOP votes.
"Why does the Michigan Constitution say we have 38 senators?" Snyder said. "Shouldn't the constitution say once a party wins the majority of chamber, why do you even bother having the other people show up? It doesn't say that."
The GOP-led House passed Medicaid expansion legislation on a 76-31 vote June 13. Twenty-eight Republicans, just under half of the 58 who cast votes, voted yes.
Though Richardville said the debate isn't over and senators will work on the issue this summer, Snyder said "not making a decision is a decision." Michigan already is behind on preparing to add 320,000 nondisabled adults earning up to 133 percent of the poverty level to Medicaid starting in 2014.
While Medicaid expansion isn't officially dead, it's on life support now. Even one of the strongest Republican backers of expansion, Sen. Roger Kahn of Saginaw Township, said a foundation has been set leaving "an opportunity for others to come and do the rest" in the future.
Snyder is counting on his bully pulpit – "take a vote, not a vacation" – to pressure the Senate to act. He so far isn't inclined to convene a special session in part because the Legislature has scheduled a July 3 session day, though no official business will be voted on.
Another possible option is vetoing all other bills until Medicaid expansion legislation gets to his desk.
"A lack of action or a no vote on this leaves us with nothing," Snyder said in fiery remarks during a Capitol news conference after he cut short a trade trip in Israel in an attempt to save one of his biggest policy priorities.
"We're basically subsidizing the rest of the United States. Isn't it better to say we're going to try a solution instead of simply saying no? … Isn't it better to try a solution knowing it may have risks, that it's not perfect, that it has challenges, that we're going to be held accountable for delivering measurable, tangible results? I accept that challenge. I believe the Michigan of the future requires us to accept that challenge and get this job done."
In many respects, it seems Snyder just wants a decision – win or lose. For nearly two years, for instance, he claimed the right-to-work measure wasn't on his agenda. But after signing it six months ago, he said one reason he did so was simply to resolve the issue.
Democrats say Snyder erred by leaving the country at a critical time knowing that contentious legislation in Lansing often gets passed in the final days before a break.
"It's incumbent on this governor to use the power of his office and put these votes together and show some leadership," said Senate Minority Leader Gretchen Whitmer, D-East Lansing.