Report reveals alternative tactics to Medicaid expansion in Republican-led Michigan is model for other states

December 4, 2014 | Publication

A report released today by the Center for Healthcare Research & Transformation (CHRT) shows that the alternative approach to passing and implementing Medicaid expansion in Michigan – a state led by a Republican governor—can be a model for other states with bi-partisan or Republican-led governments seeking Medicaid expansion.

“The number of Republican governorships retained—and gained—during the midterm elections makes Michigan’s experience in securing the Medicaid program’s expansion through the Healthy Michigan Plan particularly important,” says Marianne Udow-Phillips, director of CHRT, one of the organizations that prepared the report.

Michigan’s approach has led to success. As of November 1, 2014, nearly 450,000 people had enrolled in the Healthy Michigan Plan—Michigan’s expanded Medicaid program—and another 272,000 selected coverage through the federally-facilitated marketplace. The coverage expansions in Michigan have exceeded all projections at the state and federal levels.

This is the direct result of the coming together of key leaders representing a breadth of sectors in Michigan. In particular, the report outlines three key components to Michigan’s passage of Medicaid expansion: the governor’s interest in pursuing the expansion, the support of a strong and vocal multi-sector coalition, and the inclusion of two federal waiver requirements.

Governor Rick Snyder led the efforts of both the Medicaid expansion and marketplace enrollment by establishing a strong leadership team that worked directly with legislative leadership to create an effective environment for change. The governor’s leadership team also provided oversight of the administrative components to prepare Michigan for the coverage changes.

“Michigan’s alternative to a traditional Medicaid expansion was led by the governor and garnered just enough support from the Michigan Legislature to move forward with expanding Medicaid coverage,” says Udow-Phillips.

The Governor’s efforts on the Medicaid expansion were supported by a strong bipartisan coalition that represented the business community, providers and consumers. In particular, this coalition included the Michigan Chamber of Commerce and Small Business Association of Michigan, groups that are typically conservative but saw value in the Medicaid expansions because of projected economic growth and reduced uncompensated care.

Waivers included in the legislation were key to securing the legislature’s approval because they included features such as beneficiary cost sharing and health savings account requirements. The waivers also included health risk appraisal and wellness programs.

The report is the most recent in a series of state and regional studies examining the rollout of the ACA. The national network, with 37 states and 61 researchers, is an effort of the Rockefeller Institute of Government at the State University of New York, the Brookings Institution, and the Fels Institute of Government at the University of Pennsylvania. The Michigan report was prepared by the Center for Healthcare Research and Transformation and David K. Jones, assistant professor of Health Policy & Management at Boston University and a graduate of the University of Michigan School of Public Health.

“Michigan’s experience shows that creative, bipartisan political leadership can cut the Gordian Knot of Medicaid expansion, an issue at the cutting edge in many states for health reform,” says Richard Nathan, a senior fellow at the Rockefeller Institute and the creator of the national network.

CHRT’s report on ACA implementation in Michigan and other state reports published to date are available on the Rockefeller Institute of Government’s ACA Implementation Research Network: