Last night, the Michigan Senate approved a bill to expand Medicaid to an estimated 400,000 individuals without health insurance. Recall that while the Supreme Court decision upheld the constitutionality of the individual mandate to purchase health insurance under the Affordable Care Act (ACA), the provision that required expansion of Medicaid was deemed optional for the states. Following this landmark and controversial decision, opponents and proponents of the ACA took their fight to the states, where the arguments were spelled out in what has become an all-too-familiar dichotomy. On the one hand, proponents argue, there is an ethical imperative to assure the provision of affordable, accessible, and acceptable healthcare for every individual. Opponents counter with the unaffordable cost that is absorbed by state governments and, by extension, the taxpayers to include over 17 million more individuals over the course of the next decade.
Those arguments, however, are only two aspects of the policy conundrum, highlighting ethical and economic incentives, but overlooking the powerful role of politics in establishing health policy. The vote passed by a narrow margin of 2 votes with Michigan joining 21 other states that have opted into the Medicaid expansion. Moreover, Governor Rick Snyder was certainly not lockstep with party politics as he became the sixth Republican governor to preside over governments that favored the expansion.
Process matters. An amusing sidebar in these developments is that the initial vote was 19-18 with Sen. Patrick Colbeck abstaining. In doing so, a 20-vote majority was not obtained for passage. Consequently, a majority of senators had to approve a motion to reconsider the measure, and subsequently adopt an amendment that would limit hospital charges for uninsured patients. That would lead Senator Tom Casperson to change his vote to “yes,” thereby securing the 20-vote majority necessary for passage. Click here for a history of House and Senate actions
As we learned in our introductory course, public health policymaking entails a nuanced treatment of issues that requires us to “PEEEL” away the different layers of ‘politics, economics, epidemiology, ethics, and law.’ A sound knowledge of politics, the costs at stake, the distribution of illness or related proxies of health status (here, the scope of the uninsured), the moral imperative to assure access to care, and legislative process were all at play for proponents of the bill to successfully muster the requisite votes. This turn of events illustrates the complexity of issues and the confidence we have in training you as interdisciplinary policy advocates to identify issues and opportunities to advance population health.
Those arguments, however, are only two aspects of the policy conundrum, highlighting ethical and economic incentives, but overlooking the powerful role of politics in establishing health policy. The vote passed by a narrow margin of 2 votes with Michigan joining 21 other states that have opted into the Medicaid expansion. Moreover, Governor Rick Snyder was certainly not lockstep with party politics as he became the sixth Republican governor to preside over governments that favored the expansion.
Process matters. An amusing sidebar in these developments is that the initial vote was 19-18 with Sen. Patrick Colbeck abstaining. In doing so, a 20-vote majority was not obtained for passage. Consequently, a majority of senators had to approve a motion to reconsider the measure, and subsequently adopt an amendment that would limit hospital charges for uninsured patients. That would lead Senator Tom Casperson to change his vote to “yes,” thereby securing the 20-vote majority necessary for passage. Click here for a history of House and Senate actions
As we learned in our introductory course, public health policymaking entails a nuanced treatment of issues that requires us to “PEEEL” away the different layers of ‘politics, economics, epidemiology, ethics, and law.’ A sound knowledge of politics, the costs at stake, the distribution of illness or related proxies of health status (here, the scope of the uninsured), the moral imperative to assure access to care, and legislative process were all at play for proponents of the bill to successfully muster the requisite votes. This turn of events illustrates the complexity of issues and the confidence we have in training you as interdisciplinary policy advocates to identify issues and opportunities to advance population health.
