May 1 2013 12:00 AM

There’s a reason we have clichs. Quite often, they reflect reality.

“Cutting off your nose to spite your face.”

That is an apt description of the state Legislature as it ponders whether Michigan should be a part of the federal expansion of Medicaid. Should Michigan join most other states in expanding healthcare coverage to a half-million or more Michigan residents? Or should Michigan’s federal tax dollars go to other states so their residents can have healthcare? Should Michigan turn its back on $1.1 billion in budget savings as a matter of principle?

Those are the questions Republicans in the Legislature are beginning to answer. And, if you are one of the tens of thousands of people in their districts without health coverage, the answer so far is that ideology is more important than people — or even the state’s budget.

It is a Republicans-only debate. They hold most all the cards in the Legislature.

So far, they are saying “no” to Medicaid expansion. But that might change if federal rules allow the state to make lower-income families pay a little more.

The irony is that county-by-county healthcare statistics show the areas with the most pressing need for the program are Republican-leaning counties.

At the top of the needs list, according to a study from the Robert Wood Johnson Foundation, is a five-county area in northeast Michigan where residents are poorer, older and sicker than almost anywhere else in Michigan (Presque Isle, Montmorency, Alpena, Alcona and Oscoda counties). It’s no coincidence that those five counties have both the lowest rates of health insurance coverage in the state and the state’s highest rates of premature death. 

A study by the Michigan League for Public Policy says 43 percent to 48 percent of the uninsured in those five counties would gain coverage through a Medicaid expansion.

Most of the other Michigan counties with the highest levels of uninsured and premature mortality are in northern Lower Peninsula and the U.P. — all areas dominated politically by Republicans.

Gov Rick Snyder has included Medicaid expansion in his 2013-14 budget. So far, Snyder and his allies — as well as those half-million uninsured people — are losing.

The state House has passed a budget that omits the expansion; the Senate health budget subcommittee has followed suit. A vote on the issue by the full Senate could come as early as Thursday, although backers hope to separate the Medicaid expansion issue from the rest of the budget in an effort to broker a compromise.

It’s not just Republicans against the needs of many of their own constituents. It is also a battle against some traditionally Republican-leaning support groups.

The Small Business Association of Michigan, which historically has strongly favored Republican candidates, is pushing for the expansion. SBAM’s executive director, Rob Fowler, notes that business owners indirectly pay the cost of non-paying emergency room patients through higher insurance premiums — about $1,500 per family. Obamacare will sharply reduce those costs. Fowler’s group is joined by the Detroit and Traverse City chambers of commerce and the Michigan Business and Professionals Association in supporting the expansion.

Polling released last week by EPIC/MRA may hold the key to a compromise. 

While a majority of Michigan supports Medicaid expansion, support falls along party lines. Pollster Bernie Porn said support for expansion expands from 60 percent to 74 percent if a “personal responsibility” rider (copays and/or premium participation) is attached. Most of the added support comes from self-identified Republicans.

It plays to the mindset expressed by Mitt Romney’s famous “47 percent” statement — that nearly half the population is made up of “takers” who simply don’t pay enough for government programs and services.

“We don’t have the votes for what the governor put out,” said Senate Majority Leader Randy Richardville. “But that doesn’t mean we don’t have the votes to get something done that would expand Medicaid.”

Rep. Robert VerHeulen, R-Walker, a member of the Appropriations Public Health subcommittee, is among those who says his “no” vote could switch if there were a copay. “Even if it’s 50 cents, it’s something contributing to one’s own healthcare or well-being,” VerHeulen said. “I think that’s a healthy objective.”

The sticking point? Requiring copays will require a waiver of federal rules.

For Snyder, this is the latest challenge to his leadership from within. It hasn’t gone well for him so far. GOP lawmakers turned their back on his call to approve the International Bridge from Detroit to Windsor. (Snyder ultimately orchestrated an end-run around the Legislature.) Snyder is also getting little GOP support in his call for significant tax increases to fund repairs to Michigan roads and bridges.

Does the Governor have the political juice to produce tough votes from his own party? He hasn’t yet. Unless he reverses that record, a lot of people will continue to rely on the emergency room as their doctor’s office and the rest of us will pay the price through higher insurance premiums. Meanwhile, the rest of the nation will thank Michigan and a handful of other recalcitrant states for subsidizing healthcare for their citizens.