 why medicaid expansion should be defeated in michigan the facts  see why the michigan legislature should reject governor snyder rsquo s push to pass obamacare rsquo s medicaid expansion  the following is reprinted with permission from the michigan center for public policy blog by jack mchugh on july 1 regarding medicaid expansion in michigan  obamacare medicaid facts figures background what you don rsquo t know can hurt you posted by jack mchugh on july 1 2013 at 200pm  editor s note much of the following is derived and in some cases directly quoted from previous mackinac center articles studies and blog posts according to the ldquo official rdquo state numbers starting in 2020 the medicaid expansion will impose 300 million in annual costs on michigan taxpayers that money will have to come from either tax hikes or cuts to current government services gov snyder proposes placing half of any shortterm savings in a lockbox to cover these future cost increases  http wwwsenatemichigangov sfa publications issues medicaidexpansion medicaidexpansionproposalpdf  the mackinac center has critiqued the simplistic ldquo arithmetic rdquo approach the official estimates use because their numbers depend on shaky assumptions the shakiest being that the feds won rsquo t renege on delivering the 90 percent funding share they have promised   ldquo president obama has already signaled that increasing states medicaid share is in the administration s playbook he did so by recommending a lower medicaid lsquo blended rate rsquo in his last two annual budget recommendations rdquo    http wwwmackinacorg 18268  congressman paul ryan reinforced this point in a recent interview   ldquo it doesn rsquo t matter if republicans are running congress or democrats are running congress mdash there rsquo s no way we rsquo re going to keep those match rates like that rdquo  http wwwmackinacorg 18561  according to the heritage foundation  medicaid will impose 13 billion in net costs on michigan taxpayers through 2022  http wwwmackinacorg 18416  money for the expansion doesn rsquo t come from some ldquo pool rdquo of funds to be divided between the states but goes right onto the federal government rsquo s credit card if michigan legislators accept the medicaid expansion they will be approving an increase in the national debt of 225 billion through 2022  http wwwmackinacorg 18582  medicaid is a flawed program that serves recipients poorly according to a 2009 survey many specialists in metropolitan detroit refuse to accept medicaid patients including 33 percent of dermatologists 41 percent of family practitioners 50 percent of obstetricsgynecology specialists and 67 percent of orthopedic surgeons http wwwmackinacorg archives 2013 s201303finalpdf  according to the most important study of the program medicaid ldquo generated no significant improvement in measured physical health outcomes rdquo health care policy expert avik roy characterized the findings this way in forbes   ldquo if medicaid were a new medicine applying for approval from the food and drug administration it would be summarily rejected rdquo  http wwwforbescom sites theapothecary 20130502 oregonstudymedicaidhadnosignificanteffectonhealtho   medicaid recipients use hospital emergency rooms at twice the rate of people with no health insurance or private insurance  ldquo the obama administration rsquo s decision to push insurance coverage through a major expansion of medicaid ensures a greater number of emergency room visits hellip a s patients grapple with even more crowded emergency rooms what will be the negative impact on their access to lifesaving care in a real emergency rdquo    http wwwpoliticocom pdf ppm170hcrmedicaidpdf  many of those covered by the expansion won rsquo t be ldquo the uninsured rdquo but will be people who previously had private coverage taking advantage of a taxpayerfunded alternative in some previous expansions as many as 50 percent of the new beneficiaries dropped private coverage ldquo a conservative estimate of the proposed expansion is that medicaid rolls might have to rise by 14 people in order to reduce the uninsured by 1 person mdash a crowdout rate of about 29 percent rdquo    http wwwmackinacorg archives 2013 s201303finalpdf  the obama administration has essentially forbidden substantive state reforms of the medicaid program such as extending an innovative indiana health savings account alternative see avik roy the arkansasobamacare medicaid deal far less than it first appeared expanding medicaid in the context of implementing obamacare makes the prospect of real reforms less likely not more at this time  19 states will not expand medicaid and six are leaning against so why do our legislators think they and this state are so unique and special in this area    http wwwavalerehealthnet news spotlight 20130524medicaidexpansionpdf   michigan provides medical welfare for children up to 200 percent of the federal poverty level any claims that the expansion is ldquo for the children rdquo are just demagoguery   http wwwmichigangov documents michildfullmanual131637pdf  those pushing the expansion claim that obamacare is a ldquo done deal rdquo and we all have to just knuckle under and pay up this is wrong when the law goes into effect in just six months its complexity internal contradictions and perverse incentives are expected to inflict tremendous damage on families employers and the health care system there is a strong probability this could trigger a widespread public revolt making the law highly vulnerable to being opened up next year for major revisions by congress including the democraticcontrolled reid senate ways in which obamacare is vulnerable with evidence for each  http wwwmichigancapitolconfidentialcom 18723  mackinac center senior legislative analyst jack mchugh rsquo s testimony explaining to a house committee what vulnerable means for michigan families and businesses  http wwwmackinacorg 18741  michiganvotesorg descriptions of the medicaid expansion bill house bill 4714 note in particular differences between the bill as introduced by rep matt lori and as passed 76 to 31 in the house  http wwwmichiganvotesorg 2013hb4714 background medicaid expansion and the obamacare ldquo exchange rdquo roughly speaking there are three components to the medicaid expansion population ablebodied childless adults under 100 percent of the federal poverty level fpl people between 100 and 138 percent of fpl and individuals who are already eligible but are not enrolled the ldquo woodwork rdquo population with some exceptions the first group does not get medical welfare benefits now and will continue not getting them if this state does not expand medicaid these individuals do get treatment if they show up at a hospital emergency room they also receive a bill that most aren rsquo t able to pay so the cost of their care is shifted to everyone else the magnitude of this problem is greatly exaggerated by the hospitals mdash various measures show that uncompensated care constitutes less than 3 percent of total health care costs this is not a new problem and it would be shortsighted to solve it now at the cost of further entrenching a vulnerable obamacare sen bruce caswell rhillsdale has introduced a bill to provide coverage to this population without expanding medicaid mirs news reports it would ldquo include a limited hospitalization benefit likely capped between 10000 and 15000 rdquo and it would also pay for preventive care services sen caswell told me this approach builds on existing programs and would probably solve 90 percent of the problem at a cost he claims is not prohibitive importantly michigan would remain ldquo captain of our own ship rdquo not trapped in an expansion roach motel and not subject the whims of federal bureaucrats this below100 percent of fpl population is also the largest source of the shortterm savings this state will realize with the expansion mdash michigan will be able to transfer 200 million in mental health spending from the state budget onto the federal one it is thought that the obamacare individual mandate will drive many of the second group the ldquo woodwork rdquo people into medicaid and without the expansion michigan taxpayers will have to pay a larger share of the cost than with it however according to the snyder administration this group represents less that 10 percent of the total expansion numbers the 100138 percent of fpl population is more interesting a mackinac center study estimates this population will number 177516 people in 2014 and that 124261 of them will actually enroll in medicaid if the expansion is adopted costing michigan state taxpayers 475 million over the next 10 years without the expansion however people in this group could go into the ldquo exchange rdquo and get a real health insurance policy at little or no cost to themselves and at no cost to michigan state taxpayers the bottom line the mackinac center believes that obamacare is vulnerable to serious revision next year and this state should do nothing that reduces the chances of that outcome this big picture is infinitely more important than reforms that essentially amount to marginal changes to a problematic medical welfare program legislators and citizens who oppose the expansion on this basis are not ldquo bitter enders rdquo but are keeping their eye on what matters most 19  why medicaid expansion should defeated michigan the facts  