In the first battle, Snyder lost. His call to implement an online marketplace where the uninsured can get taxpayer-subsidized private coverage died in the GOP-controlled Legislature.
If he calls for increasing Medicaid eligibility Thursday in his budget proposal, Snyder will again find himself in the middle of a contentious fight over Michigan's role in implementing parts of President Barack Obama's signature domestic achievement.
While leaders in the medical community insist the Medicaid expansion is needed and conservatives in the Legislature label it a federal takeover, Snyder may fall somewhere in between. He opposes the federal health care law but pragmatically has tried to consider the options it gives to the state.
Snyder's backing of Medicaid expansion would not be that surprising given his try for a state-run health exchange only to end up on a path toward a marketplace controlled primarily by the federal government. Though the governor said the Affordable Care Act misses the point on how to really fix health care, he argued that having a state-operated exchange would let Michigan — not Washington — call the shots.
In 30 states led by Republican governors, five governors have called for enlarging Medicaid. The latest is Ohio's John Kasich, who on Monday reiterated his opposition to "Obamacare" and the requirement that people have health insurance but said expansion makes sense for Ohio.
Eleven GOP-led states want no part of it, and the rest are considering options.
States can refuse the expansion outright or indefinitely postpone a decision. But if they ultimately want to take the deal, it makes sense to act now.
Three years of full federal funding for newly eligible enrollees are only available from 2014 through 2016. The federal government will pick up 90 percent over the long haul. The match rate for existing Medicaid participants is 66 percent.
To qualify, household income must be below 138 percent of the federal poverty level, about $15,000 for an individual.
Those lobbying for more Medicaid coverage in Michigan are appealing to the governor's pride in making data-driven decisions.
"There really is no downside," said Gilda Jacobs, president and CEO of the Michigan League for Public Policy, which advocates for the poor.
Jacobs, a former Democratic state senator, said it is "simply the right thing to" for single adults who do not make enough to buy insurance and low-income uninsured parents whose children have Medicaid insurance. It would give Michigan businesses a healthier workforce, decrease expensive visits by uninsured patients to emerge rooms and — echoing what Kasich told Ohioans — bring federal tax dollars here rather than other states, she said.
Also lining up on the side of expansion are Democrats, hospitals, insurers, doctors and mental health advocates. Proponents on Monday delivered Snyder 4,000 signatures asking that he expand Medicaid.
On the other side are some Republicans along with conservative and tea party organizations.
Their worries include whether deficit-burdened Washington will renege on the 90-percent deal and a philosophical resistance to expanding government programs, particularly one as large as Medicaid.
"There's a scary inclination for our state lawmakers to view federal money as free and it's not," said Annie Patnaude, deputy director of Americans for Prosperity-Michigan, which sent letters in opposition to every legislator and emailed 88,000 activists around the state. "The Medicaid expansion is one more way Obamacare is being foisted on the states."
Snyder himself has cited two primary concerns while making his decision — whether the medical community could handle the additional caseload and the price tag when Michigan would have to pay some of the freight starting in 2017.
On the capacity question, the governor has received encouraging feedback. Eight in primary care physicians anticipate being able to accommodate newly insured patients in 2014, when the health law takes full effect, according to a study released last week by the Center for Healthcare Research & Transformation in Ann Arbor.
On the question of the cost to Michigan down the road, studies show the state would save hundreds of millions of dollars a year initially because more people who now receive mental health services and medical care from state-funded programs will instead be covered with federal money. In 2020 and beyond, the state could be paying tens of millions of dollars more each year.
Still, nonpartisan legislative analysts have characterized Snyder's decision as more of a policy issue than a fiscal one.