LANSING, Mich. (AP) - Gov. Rick Snyder warned Tuesday that House Republicans' federal health care bill would hurt 1.75 million residents in Michigan's traditional Medicaid program and end the expansion of coverage to more than 650,000 others.
In a letter to each Michigan member of Congress, Snyder also expressed concern that the legislation would make it too expensive to buy insurance in the individual market, particularly for older residents who could see "significant cost increases."
It was the second time less than a week that Snyder spoke out. He joined three other Republican governors last week to write a letter to congressional leaders opposing the bill and proposing their own plan to overhaul Medicaid for low-income people.
The GOP-led House is scheduled to vote Thursday on the legislation. If it passes, the bill faces an uncertain future in the Republican-controlled Senate.
Snyder told Michigan's House members how many Medicaid enrollees live in each of their districts, including children and the disabled.
The proposed American Health Care Act, he said, "shifts significant financial risk and cost from the federal government to states without providing sufficient flexibility to manage this additional responsibility." He said the debate has largely focused on Medicaid expansion that was authorized under the federal health law, but many more people are in the traditional Medicaid program.
"As you know, these are our state's most vulnerable citizens, friends and neighbors. The proposed AHCA will adversely impacts them," Snyder wrote.
Michigan has two Democratic senators. Republicans have a 9-5 edge in the House delegation.
Snyder, a strong proponent of the state's Medicaid expansion program that is primarily paid for by the federal government, said it has led to reductions in uncompensated care, fewer people using the emergency room for regular care and increased primary or preventive care visits. If Michigan were forced to assume responsibility over time for up to $800 million in additional costs, he said, that would trigger a provision in state law ending the expansion.
The nonpartisan Senate Fiscal Agency this month projected that the expansion would end a year sooner in Michigan - in 2020 - if the federal legislation becomes law. Under state law, the expansion already will end once net costs exceed net savings, which currently is projected to occur in 2021 barring legislative action.
Snyder told Michigan's delegation that he and the Legislature need flexibility to manage the risk of asking states to potentially pay higher Medicaid costs. He said President Donald Trump's administration might provide more flexibility, but "I am concerned that federal agencies may encounter limitations in federal statute. Ultimately, Michigan cannot rely solely on the promise of future action without seeing all of the tools that will be at our disposal to manage the program."
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