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    The Patient Protection and Affordable Care Act (PPACA), also known as Obamacare, is causing many decisions to be debated by Michigan's legislature. Currently, the implementation of Michigan's health exchange is on the table along with whether or not Michigan will decide to expand their Medicaid program. Under the PPACA, which was signed into law by President Obama on March 23, 2012, all states are required to have their own health insurance exchange. States can either decide to design and operate their own exchange or hand the duties over to the federal government. Along with this, states also have to decide whether or not they want to expand their Medicaid program. While Governor Rick Snyder has favored a state-run health insurance exchange and a Medicaid expansion, he is still having trouble gaining support from conservatives. .
    Until recently, it was still unknown what type of health insurance exchange Michigan would agree upon. A vote on November 30, 2012 by the House of Representatives Health Policy Committee made it clear that Michigan will most likely be forming a "partnership" exchange run primarily by the U.S. Department of Health and Human Services (HHS). These partnership exchanges are still being defined by the federal government at this point. Under the law, it clearly states that, "If a state chose a partnership exchange that is prima facie evidence that the state chose not to establish an exchange itself." For Michigan, this might mean that the health insurance exchange will predominately be handled by the federal government even if it is considered a "partnership." The biggest reason why the committee would not agree upon a state-run exchange is due to the fact that they could not guarantee that a state-run exchange would protect Michigan citizens. These exchanges are intended to help insurers compete easier in a larger market and to make it easier for consumers to compare insurance prices. The exchanges will also bring new consumers in due to the requirement that all Americans must purchase health insurance. Governor Snyder is still hoping that once Michigan's partnership exchange is up that Michigan can convert to a state-run exchange.

    Recently, the federal government gave Michigan a $30.6 million grant from the HHS for the planning and implementation of the health exchange. Michigan is only one of eleven states that will be receiving a shared $1.5 billion in grants. This grant will go to the Michigan Department of Licensing and Regulatory Affairs to analyze the impact of the health insurance exchange and to cover various costs that are affiliated with setting up the exchange. When the PPACA was first passed, the HHS was expecting the states to run the health exchanges themselves. That quickly changed when many of the states showed uncertainty in agreeing to state-run exchanges. Since then, the HHS has been very generous in giving grants to the states that show possibilities of having state-run exchanges. All exchanges are supposed to be fully certified and operational by January 1, 2014, so it is no wonder that the HHS is trying to speed the process along.

    Along with debating the various health insurance exchange proposals, Michigan also has to decide whether or not to expand Medicaid legibility under the PPACA. The Supreme Court ruled last June that states could choose whether or not to opt into the Medicaid expansion. If Michigan did choose to opt in, then the federal government would pay for the costs of expansions for the first three years. After the three years are up, the federal government would pay 90% of the costs. While most conservatives want to turn down the large sum of federal money, many other state officials see the benefits that the money could offer to the states.

    Currently, Governor Rick Snyder is trying to persuade lawmakers that an expanse in Medicaid eligibility would not only cover more people in need, but it would also help to fix Michigan's underfunded mental health care system. Although Snyder sees that Medicaid expansion would be beneficial to the low-income people in Michigan, he is also questioning whether or not Michigan doctors would be able to handle the large amount of new patients that would be added to the program. Besides expanding to cover families making 133% of the poverty level, expanding Medicaid would also provide expanded assistance to people needing of mental health care. Expanding Medicaid would add an estimated 300,000 people to Michigan's Medicaid rolls by next year. Most of the people who would be newly covered would be low-income adults who have no children. This would also cause the number of uninsured people in Michigan to drop from an estimated 1.1 million in 2010 to 290,000 in 2020. While many lawmakers wonder what Medicaid expansion would cost the states and taxpayers in the future, others believe that with the money pledged by the federal government would make it well worth the expansion. In response to many lawmakers' fears, Snyder has proposed the creation of a new health savings fund that would collect money to pay for future health care costs.

    Sources:

    http://www.battlecreekenquirer.com/article/20130104/OPINION01/301040033/Editorial-Expanding-Medicaid-right-move-Michigan?nclick_check=1

    http://tpmdc.talkingpointsmemo.com/2013/01/republican-governors-medicaid-expansion.php

    http://www.michiganradio.org/post/michigan-leaders-still-weighing-expansion-medicaid

     

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    The Michigan Policy Network is a student-led public education and research program to report and organize news and information about the political process surrounding Michigan state policy issues. It is run out of the Department of Political Science at Michigan State University, with participation by students from the College of Social Science, the College of Communication, and James Madison College. 

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