LANSING - State Sen. Tom Casperson said Wednesday his initial no vote against Medicaid expansion had been the result of a misunderstanding between him and the state Senate majority leader.
Casperson, R-Escanaba, eventually voted for the bill, becoming the deciding vote in the 20-18 vote Tuesday to expand Medicaid to include more than 400,000 uninsured Michigan residents.
He had initially voted no earlier Tuesday, when it appeared the expansion had been voted down 19-18.
Photo courtesy Senate PhotoWire
State Sen. Tom Casperson, R-Escanaba, is seen on the Senate floor in this undated file photo. Casperson cast the deciding vote Tuesday on Medicaid expansion after voting against the measure on the previous vote.
"I thought that plan was that we were going to meet one more time to discuss that particular bill," he said.
In a Detroit News article Wednesday, State Senate Majority Leader Randy Richardville, R-Monroe, accepted blame for the miscommunication.
Casperson agreed to change his vote after an amendment was added that capped the rate at which hospitals can charge uninsured patients at 115 percent of that charged to Medicaid patients. Right now, he said, those rates can be up to three times as high.
"I think there needs to be a balance there," he said.
Casperson also proposed another amendment on Medicare reimbursement rates. He said Gov. Rick Snyder's administrative and the Senate appropriations chair had agreed to take it up during the next budget cycle in 2014.
The legislation now returns to the GOP-led House, which passed the bill in June and is expected to send it to Gov. Rick Snyder next week for his signature. The GOP governor, who strongly supports Medicaid expansion, had struggled to win backing in a Senate where many conservatives opposed to "Obamacare" have philosophical objections to expanding government.
The Senate fell two votes short of giving the bill immediate effect, which may force new Medicaid recipients to wait until April for coverage instead of January. Snyder said he was hopeful the Senate would revisit the timing, asking "should we make people wait three more months?"
Medicaid expansion is part of a strategy to ensure nearly all Americans have health insurance under the 2010 Affordable Care Act. It was designed to cover the neediest uninsured people but became optional for states because of a Supreme Court decision last year.
Many GOP-led states have declined the expansion, despite the U.S. government promising to cover the entire cost for the first three years and 90 percent later. Michigan is poised to become the seventh state led by a Republican governor to sign up.
Pressure from advocates of Medicaid expansion had been building in order for the state to receive federal OKs before residents can enroll.
Medicaid already covers 1.9 million, or one in five, Michigan residents - mainly low-income children, pregnant women, the disabled and some poorer working adults.
The legislation would cover adults making up to 133 percent of the poverty level, or $15,500 for an individual and $26,500 for a family of three.
The bill includes GOP-written requirements that nondisabled enrollees pay some of their medical expenses after six months and pick up more costs after getting Medicaid for four years. They could lower their costs by not smoking or adhering to other healthy behaviors.
The newly eligible also would no longer be covered if savings from the expansion - primarily from shifting state mental health costs to the federal government - do not cover the state's cumulative costs. The nonpartisan Senate Fiscal Agency estimates the expansion would stop in 2027.
Supporters contend that offering health insurance to more poor people will make them healthier and minimize their expensive trips to the emergency room, saving money throughout the health system and also helping businesses meet requirements under the health law.
Opponents question such a large government expansion when the U.S. is trillions of dollars in debt and are suspicious of money-saving claims. Tea party and conservative activists say they will oppose Snyder's expected re-election bid because of his push to expand Medicaid coverage.
Casperson said while he remains opposed to the federal health care expansion under the Affordable Care Act, a no vote on the state bill would only mean more federal control.
"A no vote for me was telling the federal government 'I want you to run it, we're not going to touch it,'" he said. "It doesn't stop Obamacare. Not one inch ... I don't see how anyone could think the federal government would do it better than the state."