By Jonathan Oosting | 
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on August 31, 2013 at 8:00 AM, updated August 31, 2013 at 8:35 AM

LANSING, MI — Michigan Gov. Rick Snyder wants to reform Medicaid and expand eligibility under the auspices of the Affordable Care Act, and a total of 36 Republicans in the House and Senate have now voted for the “Healthy Michigan” plan.

But they want you to know they still don’t like Obamacare. In fact, many of them really, really hate it. Consider the following comments from Sen. Howard Walker, R-Traverse City:

Howard Walker

“The Affordable Care Act, also known as Obamacare, is one of the worst pieces of legislation passed by our United States Congress in many years. It takes health care decisions away from our people; it penalizes those who choose not to purchase health care coverage; it places new mandates on small business owners; and it cuts funding to our local hospitals and health care providers, among other negative aspects.”

Walker delivered those remarks Tuesday night on the Senate floor. Then, he voted for House Bill 4714, which would allow the state to appropriate up to $1.7 billion in federal funding next year in order to expand Medicaid eligibility under the Affordable Care Act. If the House approves changes and Snyder signs the bill, the spending eventually will help cover an estimated 470,000 residents who might currently lack insurance.

Despite his opposition to the federal health care law, Walker explained that Medicaid reforms included in the legislation made expansion more palatable. Besides, he said, uninsured citizens are “essentially getting free health care” when they visit emergency rooms, and uncompensated care isn’t good business for hospitals.

“I am hopeful that a day comes where Obamacare is no longer the law of the land,” he said. “Until that time, I must ensure that we limit cost-shifting in our hospitals and that our hospitals’ doors remain open. I feel this legislation was the most viable way to do so.”

Throughout the legislative process, Snyder argued that Medicaid expansion made fiscal sense for Michigan. It will reduce uncompensated ER care, he said, lead to a healthier workforce and actually save Michigan millions in general fund spending in early years because some individuals currently covered by the state will be moved onto Medicaid.

But it wasn’t the state savings that won over reluctant Republicans, it was the business implications and reforms, including co-pays, income-based premiums and a 48-month cap on coverage for able-bodied adults, who could have the choice to stay on Medicaid and pay higher premiums or get private insurance through an upcoming exchange.

Michigan’s exchange will be run by the federal government because Republicans previously refused millions in funding to set up a state-run exchange or partner with Washington on the operation. Snyder supported state involvement as a form of “customer service.”

Medicaid expansion marks the first occasion that Michigan’s Republican-led Legislature has agreed to go along with a significant provision of the Affordable Care Act. And many members suggested they had to hold their noses while doing so.

“It takes healthcare decisions away from our people, it penalizes those who choose not to purchase healthcare coverage, and it places new mandates on small business,” Sen. Mike Kowall, R-White Lake, told his constituents a day after he voted for HB 4714.

“However, there was a United States Supreme Court decision finding that the law is constitutional. If Michigan did not form its own plan, the Affordable Care Act would harm our taxpayers and would result in employers leaving the state.”

Michigan Democrats widely supported the Medicaid expansion, and U.S. Rep. John Dingell of Dearborn, who helped author the Affordable Care Act, even visited the Legislature in July in hopes of pressuring the Senate to vote on the matter.

As Walker and Kowall suggested, Republican votes did not come easy, and even if the eight senators who said “yes” were motivated by pragmatism, there may be political consequences for some of those who supported the “Healthy Michigan” plan.

Tea party groups already have promised primary challenges against some House and Senate Republicans, they’ve urged conservatives to “sit out” a Snyder re-election campaign and are planning to oppose Lt. Gov. Brian Calley’s nomination at the GOP convention next year.

Calley, who has been under fire in recent weeks from Medicaid expansion opponents, couched his support for Medicaid expansion in conservative-friendly language when he joined the governor at a press conference after Tuesday night’s Senate vote.

“This is a victory for those who will gain coverage,” he said, “but this is also a victory for those who are lovers of liberty.”

Liberty, he explained, because people who choose to go on the state-administered Medicaid program would have otherwise been forced to purchase more expensive insurance on Michigan’s federally-run health exchange or face a tax penalty beginning next year when the Affordable Care Act’s individual mandate kicks in.

“This is a big victory for people who are worried about the next generation and the overall cost they would be saddled with,” Calley continued, “because the Michigan Medicaid program is so much more efficient than the alternative.”

Wes Nakagiri, a tea party leader from Hartland who recently announced his plans to seek the Republican nomination for lieutenant governor next year, suggested Calley didn’t understand the definition of “liberty” and criticized the Medicaid vote.

“It is disappointing that the party of ‘smaller government’ voted to pile even more debt on the backs of future generations of Americans,” Nakagiri said.

Michigan Republicans clearly are divided on Medicaid expansion, and reasonable minds can disagree on whether it is a “civil war” or more of an “intense fellowship.” But they aren’t fighting over support for Obamacare — publicly, at least, they’re fighting over who hates it most.