LANSING (AP) - Gov. Rick Snyder's attempt for legislative approval of a new health insurance market in Michigan has been a 1.5-year odyssey - and it's not over yet.
The GOP-led Senate quickly got behind his state-run marketplace, or online exchange, in 2011 so the state could have more say in a key component of the federal health care law that will help people shop for required insurance. But House Republicans opposed to the law resisted throughout 2012, even after President Barack Obama's re-election.
With Plan B, the governor pitched a partnership website controlled almost entirely by the federal government. The House assented to spending $31 million in federal money for the exchange - reasoning the contentious law is here to stay - only now support may be fading among Senate Republicans.
Gov. Rick Snyder and Jacqueline Morrison, State Director, AARP Michigan, listen during a press conference announcing Medicaid expansion in Lansing recently. The state’s health care overhaul has now shifted to creating an insurance marketplace. And it’s not going smoothly. (AP photo)
"I just won't play their shell game. I won't drink their Kool-Aid. I won't agree to take their funny money," said Sen. Mike Green, R-Nashville.
It's an about face for Green, who voted for an exchange in November 2011.
With pressure from conservatives and tea party groups mounting, Senate leadership may have to break with custom to send Snyder the spending measure.
Votes typically are not allowed unless legislation has backing from a majority of the majority party. The first time around, the number of Republicans in support was narrow, 13-12, and it appears more in the GOP now may be against it than for it. All 12 Democrats backed the state-run exchange, too.
Senate Majority Leader Randy Richardville, R-Monroe, is considering whether to hold a vote and said he will not be rushed. His caucus heard the pros of partnering with federal officials from a Snyder cabinet member on Thursday, the same day the Obama administration conditionally approved Michigan's plan. The state has to submit a proposal for consumer outreach and assistance at month's end, a difficult task without authorization to spend money, according to state officials.
"It's in a different form," Richardville said of the partnership market as opposed to a state-run exchange. "But I think this is a tough thing for any conservative that doesn't like the idea of some kind of mandated federal Big Brother health care. And so it's difficult for people to now have to accept that it's forced upon them and we have to try and make it work."
The website and accompanying call center are supposed to make it easier for people to shop for the insurance they must have in 2014 - or pay a penalty. Also open to small businesses, the Expedia-like exchange will be used in part to determine people's eligibility for Medicaid and, if they buy private insurance through the website, whether they qualify for income-based federal aid to help pay their premiums.
A partnership would let Michigan handle some customer service functions and approve insurers wanting to offer health plans on the exchange, which Snyder argues would save them from an extra layer of regulation and prevent the state from having to spend its own money.
"It is the choice to support our own businesses here in Michigan," said Sen. Roger Kahn, a Republican from Saginaw Township. "If we reject this, it is a federal-only exchange. ... We lose our seat at the table on making decisions going forward."
But Sen. John Pappageorge, R-Troy, who voted for the state exchange in 2011, is having second thoughts.
"Having read the fine print, I realize that the only thing we're going to be in charge of is the complaint department of an act we don't much care for. So it is perfectly consistent to say yes to a state-run Orbitz-type organization and no to one where the feds actually run the store and call it a cooperative arrangement."
One big reason some senators are hesitating is outside pressure.
Conservative organizations, Tea Party supporters and other vocal opponents of the federal health law are calling and emailing lawmakers.
One leading the opposition is Jack Hoogendyk, a former state House member and U.S. Senate candidate who runs the Citizens' Alliance for Life & Liberty and the Madison Project Michigan PAC.
He says an exchange will be put in place, but there is no reason Michigan needs to help do it.
"Anytime you take money from somebody, there's a string attached," he said, calling the $31 million grant a "bribe."
Some speculate that some Republicans are worried about facing 2014 primary challenges if they vote in favor of the insurance market. Yet Hoogendyk said his focus is finding conservatives for open races, not to "take somebody out because of a couple of bad votes."
At least 364,000 Michigan residents are expected to get private insurance through the exchange in 2014, with many receiving government help to pay premiums. Depending on how many businesses use the website, a maximum of nearly 1.4 million people could be enrolled next year, according to the state Department of Licensing and Regulatory Affairs.
"We're getting less and less input every day that goes by that we don't assert ourselves," said Senate Minority Leader Gretchen Whitmer, D-East Lansing. "We have a duty to our constituents. They deserve to have their voice in how this is run."