A new draft version of legislation that could be voted on as early as Tuesday no longer includes a hard, 48-month time limit for nondisabled adults added to the government health insurance program under the contentious federal health care overhaul. Instead, those adults ages 21 to 64 would have two options after four years: buy government-subsidized insurance through a new health marketplace — known as an exchange — or stay on Medicaid by paying more out-of-pocket costs.
The time limit was touted as the first such proposal in the country when it was introduced a month ago. But it had drawn concern from Republican Gov. Rick Snyder, Democrats and advocates for the poor. The four-year cap would be significantly softened under a draft bill to be considered in a GOP-led House committee.
The legislation still would call for the creation of individual health savings accounts for recipients, who could lower their premiums and co-pays by being healthy — not smoking, for instance, or losing weight.
"We are trying to find a way to meet our goal and compromise with people enough for them to support the reforms we are trying to make," Ari Adler, spokesman for House Speaker Jase Bolger, R-Marshall, said Monday. "We wanted people to start taking personal responsibility for their health. ... What we have is great reform that fixes the broken status quo."
Snyder, who has made Medicaid expansion a major priority, called changes to the legislation a "key step forward." Expansion of the health insurance program was not included in a recent state budget deal, but his administration and legislators have continued talking.
"We look forward to working with the Legislature in the coming days to move forward on this critical issue and make a healthier Michigan a reality," spokeswoman Sara Wurfel said.
Snyder is among nine Republican governors to support or accept expanding Medicaid to adults making up to 133 percent of the poverty level — $15,300 a year for an individual — a major component of the health care law taking effect Jan. 1. It is designed to provide coverage to 470,000 Michigan adults in the future if the state accepts.
Washington would pick up the full cost for the first three years and 90 percent over the long haul, but the option is dividing GOP lawmakers in part because it is an expansion of government.
The amended bill also would no longer require legislators to reauthorize the Medicaid expansion when the federal government stops covering the entire cost in 2017 or makes any other funding changes. The state instead would automatically stick with the expansion when funding drops below 100 percent if savings from the expansion cover Michigan's additional costs, Adler said.
Snyder and others have argued that making more poor people eligible for Medicaid will reduce the uncompensated cost of uninsured patients going to the emergency room. They further contend the cost of Medicaid recipients not getting preventive care ultimately is passed to those with employer coverage or their own plan.
Also, the state would save $200 million a year initially because more people covered by state aid would be covered with federal aid.
Assuming the bill wins approval from the House Michigan Competitiveness Committee on Tuesday or Wednesday, Adler said the full House could vote Thursday to send it to the GOP-controlled Senate. Legislators are scheduled to break for the summer June 20.
Advocates of Medicaid expansion reacted positively to the substitute legislation Monday.
"The process appears to have produced a bill that achieves all the goals we set out to achieve," said Roger Martin, spokesman for Expand Medicaid, a coalition of hospitals, insurers, doctors, small businesses and others.
Medicaid covers roughly one in five Michigan residents — mainly low-income children, pregnant women and the disabled along with some poorer working adults.
The U.S. government would need to grant a waiver for Michigan to proceed with changes included in the House bill. Conservative groups are pressuring Republicans to oppose expansion, and it is uncertain if Democrats ultimately would vote to make low-income adults staying in Medicaid after four years pay 7 percent of their income for out-of-pocket expenses.