LANSING — The state Senate narrowly voted Tuesday night to make more low-income adults eligible for Medicaid, a major step toward Michigan becoming the 24th state to accept a key component of the contentious federal health care law.
The GOP-led chamber, on a 20-18 vote, approved expanding the government health insurance program to nearly a half-million Michigan residents within a few years. Many are expected to be eligible in 2014 depending on when the state receives federal approval.
Republicans hold a 26-12 majority in the Senate. Fewer than half joined Senate Majority Leader Randy Richardville of Monroe to support the measure.
The legislation 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 for months to win backing in a Senate where many conservatives opposed to “Obamacare” have philosophical objections to expanding government.
The Senate did not get enough votes to give the bill immediate effect, which may complicate how quickly the expansion can occur in 2014.
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.
In Ohio, Republican Gov. John Kasich supports the expansion, but the General Assembly’s debate is on hold.
The legislation in Michigan passed three hours after the Senate fell one vote short on its first try, when Republican Sen. Tom Casperson of Escanaba surprised all by voting “no.” That allowed one of the fiercest opponents of the health-care law, Sen. Patrick Colbeck of Canton Township, to not vote, preventing Republican Lt. Gov. Brian Calley from breaking a tie.
Mr. Colbeck said he was concerned about the increasing state contributions in later years. The federal government has pledged to cover the costs for the first three years, with the state gradually paying up to 10 percent of the cost by 2020. “The bottom line is we’re spending more money,” Mr. Colbeck said, calling the expansion “a path to a single-payer system where nobody gets control of their health care.”
Mr. Casperson voted “yes” the second time around after the bill was amended to limit the amount hospitals can charge the uninsured for medical care.
Pressure from advocates of Medicaid expansion had built for the state to receive federal approval before Michigan residents can enroll starting Oct. 1.
Medicaid 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 almost a half-million more 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 new enrollees pay some medical expenses after being on the program for six months and more after getting Medicaid for four years. They could lower their costs by not smoking or adding healthy behaviors.