Meet The Only Republican Governor Defending Medicaid

Inside Health Policy’s Amy Lotven points out that Michigan Gov. Rick Snyder (R) is the only Republican governor to opt out of a GOP governors’ letter asking the federal government for greater state “flexibility” to make reductions to the Medicaid program and calling for the repeal of the Affordable Care Act. Instead, Snyder has sent off his own letter to Energy and Commerce Chair Fred Upton (R-MI) in which he argues that program efficiencies and grants from the federal government have allowed the state “to spend less general revenue on the program than it did a decade ago, even as enrollment has doubled.” These innovations — including a greater investment in managed care and a grant from the federal government that focuses on dual eligibles — have helped the state maintain its Medicaid services.

Snyde has also instructed the state’s Department of Community Health to implement the measure:

In a separate letter to Upton, Snyder said the state had been able to balance its budget without cutting eligibility, optional services or provider payments. He also referenced the September message on health and wellness.

Since he took office, Snyder has sought to avoid comparisons with other new GOP governors, particularly those in Wisconsin and Ohio who quickly sought to enact controversial limits on public employee collective bargaining rights.

When thousands of protesters were rallying in the Capitol in Madison in February, Snyder pointedly said Michigan “was not” Wisconsin.

Snyder has not called for repeal of the federal health care law and his Department of Community Health is proceeding with its implementation, which includes the establishment of a state-level insurance exchange that would give consumers personal insurance market greater choice and access to coverage.

Implementation of the ACA will actually help Snyder strengthen the Medicaid program. The law provides states with a lot of extra cash, insures more residents and — consequently — allows states to “reduce payments they make to support uncompensated care costs.” The federal government picks up the entire tab of Medicaid expansion until 2016. The government will pay for 95 percent of the expansion in 2017, 94 percent in 2018, and 93 percent in 2019. Beginning in 2020, the federal government will fund 90 percent of the expansion. Significantly, the law will also allow an enhanced match to the 11 states that already cover childless adults below 133 percent of the federal poverty level (the 11 states will begin receiving higher federal matching funds for this population until all states receive 93 percent federal matching rate by 2019). The increases in state spending are very small compared to “increases in coverage and federal revenues and relative to what states would have spent if reform had not been enacted.”

So Snyder is the only Republican governor who is making sense on the Medicaid point. The mainstream GOP line is nonsensical: they’re arguing that they don’t have enough money to sustain their existing programs on one hand, but reject extra ACA dollars on the other. That kind of approach only positions them for making drastic cuts that would impact benefits and enrollment. But then again, they were never interested in public safety net programs in the first place.