Macomb health agencies support Medicaid expansion

Some concerned about the long-term costs

By: Nico Rubello | Fraser - Clinton Township Chronicle | Published April 29, 2013


During a recent stop in Harrison Township, Michigan Gov. Rick Snyder advocated that Medicaid expansion made fiscal sense for the state.

“What I’ll tell you is very few subjects are as polarizing as the federal Affordable Care Act, where many people just get emotional and they don’t have an opportunity to fully look at the facts,” Snyder told the crowd of civic and business leaders while keynoting a luncheon.

The Republican governor has proposed expanding Medicaid up to 133 percent of the federal poverty level. Medicaid is a federal- and state-subsidized program that reimburses physicians and hospitals for health care services for qualifying low-income individuals.

Under the proposal, the federal government would cover 100 percent of the state’s expansion costs through 2016, and then gradually reduce funding to 90 percent by 2020. The state would take up the other 10 percent.

Estimates say the expansion would add about 470,000 Michigan residents to the Medicaid program, including more than 40,000 in Macomb County.

But Snyder’s endorsement of Medicaid expansion hasn’t necessarily brought the GOP-led state Legislature on board. A state House Appropriations subcommittee responsible for the state Department of Community Health budget approved the budget without the Medicaid expansion accounted for.

Ari Adler, a spokesman for House Speaker Jase Bolger, said the expansion was left out of the House’s budget because the expansion wasn’t guaranteed yet. “All we’re saying is we don’t know yet,” Adler added. “We’re not going to count on that money.”

Some House Republicans have said they are concerned about expanding Medicaid to hundreds of thousands of additional Michigan residents and then having the state left on the hook if the federal government were to back out of its funding commitment later.

Studies have predicted that the expansion will save Michigan up to $1 billion over the next 10 years. Snyder has proposed funneling half of the savings into a savings account to sustain the expanded program past 2020.

And that’s a responsible move to make, Adler said. But what if the federal government decides to drop its commitment below 90 percent? It’s a lot easier to put more people on Medicaid than it is to cut them off later, when funding becomes unsustainable, he added.

In Macomb County, those supporting expansion from a public health perspective say that access to health care will translate to a healthier population.

Barbara Rossmann, CEO of Henry Ford Macomb Hospitals, said it makes sense for the state to expand the program, given the fact that hospitals are seeing Medicare reimbursement reductions over a period of 10 years with the expectation that the difference would go to expand Medicaid. But last year’s U.S. Supreme Court decision on the federal Affordable Care Act upheld the law but made it possible for states to opt out of the major Medicaid expansion, and the verdict left Michigan and other states debating whether to accept the expansion.

If the state doesn’t expand the program, those dollars will go to other states, Rossmann said.

Advocates of expansion, like Rossmann, add that Medicaid saves money in the long haul because insured people are more likely to get treatment when medical ailments first arise, as opposed to going to the emergency room later when they’re more serious — and more costly.

“The key here is we have an obligation to help our community be as healthy as possible,” Rossmann said.

Within the realm of substance abuse treatment, Monique Stanton, president and CEO of CARE of Southeastern Michigan, said Medicaid expansion would grow to cover an estimated 90-95 percent of all uninsured Macomb County residents who otherwise are waiting for funding to free up to pay for treatment.

In Macomb County, any uninsured person in need of substance abuse treatment must go through the Fraser-based CARE, a nonprofit that connects them with treatment providers. Right now, if an uninsured individual contacts CARE to access treatment for substance abuse, they often are wait-listed while they wait for dollars to free up to pay for their treatment.

“Individuals aren’t so much waiting for a physical bed to open up; they’re really waiting for dollars to pay for that bed to open up,” Stanton said.

The longer somebody waits for treatment, the less likely they are to follow through and successfully complete treatment once it becomes available, she said. Without treatment, many just continue their substance abuse.

“They wait significant amounts of time, depending on a variety of criteria,” Stanton added. “Last year, we had over 1,000 people wait for treatment. The longest an individual waited was 141 days, and that person actually never made it into treatment.”

Medicaid expansion in Michigan has garnered support from the likes of the Michigan Department of Community Health, the Michigan Health and Hospital Association and the Michigan Association of Community Mental Health Boards.

John Kinch, executive director of Macomb County Community Mental Health, agreed that expanding the program would open mental health services to more individuals who otherwise would not have any health care coverage.

While there is not currently a waiting list for mental health services in Macomb County, Kinch said the agency is “getting close” to having one because of declining state appropriations, he said. Macomb County Community Mental Health has lost about $4 million from the state during the last five years. It amounts to fewer than 2 percent of the roughly $217 million allocated, he said, but the demand is so great that even the loss of a few million dollars would still be enough to force some consumers onto a wait list for services.

Medicaid expansion would compensate for those losses and help the agency provide services to more people. “The revenue from Medicaid expansion goes all into consumer services,” Kinch said.

But Ted O’Neil, media relations manager for the Mackinac Center for Public Policy, said the Midland-based think tank agreed with those who say that taking the expansion would be risky, should the federal government not live up to its promise.

O’Neil said the program could end up drawing more people than expected, making it cost states more over time than any projected shorter-term savings.

The Mackinac Center also has pointed to other states that have expanded Medicaid in the past. For example, a 2000 Arizona expansion that drew more than twice the number of people expected to the program and, as a result, cost the state higher much more than it had initially estimated.

Opponents also have suggested that, because Medicaid reimburses doctors at a lower percentage than private insurance, increasing the patient-to-physician ratio would reduce the number of physicians willing to see patients on the program.

Still, others are concerned about the long-term effects of adding hundreds of thousands of Michigan residents to the program, and they say that the move still equates to an increase in government spending at a time when the public sector should be cutting back.

Also, they add, while the federal government is bearing most of the costs, it is still taxpayers who are footing the bill.

Whether the state opts to go with the expansion or not, Snyder said the state will enact a federal exchange change program as part of the Affordable Care Act. Some, including the governor, advocate that a state exchange should follow.