The case against the expansion of Medicaid is a weak one, the case for it a no-brainer. It will save lives, and ultimately it will save money. Making it happen should be at the top of Gov. Rick Snyder's to-do list in 2013.
When the Supreme Court ruled to uphold the Affordable Care Act last summer, it made Medicaid expansion optional for the states, creating yet another wedge issue in legislatures across the country.
Under the legislation, Medicaid - the joint state-federal government health insurance program for lower-income Americans - would be expanded to cover those making 133 percent of the poverty level.
For the first time, low-income adults without children would be guaranteed coverage through Medicaid. In Michigan, it would add an estimated 500,000 people to the Medicaid rolls on Jan. 1, 2014.
Although the cost-benefit analysis can be complex based on current enrollment levels in each state, the debate has followed partisan lines.
Strong Republican states such as Texas declared early on they weren't interested. In all, nine have decided against participating while five are leaning that way.
Fourteen have decided to expand coverage while four are seen as likely participants.
Michigan is among 17 states that are officially "undecided," although Snyder has already said that expanding Medicaid would likely save the state money.
There's plenty of evidence to back that up. A report released in October by the nonprofit Center for Healthcare Research & Transformation and several economists at the University of Michigan concluded that the state could save hundreds of millions over a decade even while increasing enrollment by more than 600,000 people.
The Congressional Budget Office released a report back in July that estimated the additional cost to states from the expansion to be a 2.8 percent increase over what they would have spent on Medicaid from 2014 to 2022 without health reform. But that report doesn't take into account the savings under the expansion.
States already shoulder billions of dollars annually to care for uninsured residents in hospitals, and billions more for uninsured mental health patients who would be covered under this provision of the act.
The October report projected that the total number of uninsured in the state would drop from 1.1 million in 2010 to 290,000 in 2020 if Medicaid eligibility were expanded in Michigan.
The federal government has pledged to pay the full tab the first two years and ultimately 90 percent of all costs after that, so it's hard to see how this wouldn't make sense for Michigan.
Ultimately, though, the expansion is designed to improve the health and lives of people with limited means. There's evidence for that, too. Results of a study by doctors at the Harvard School of Public Health, published in the New England Journal of Medicine, showed a correlation between improved health care and Medicaid expansion since 2000.
The study compared three states (New York, Maine and Arizona) with expansions with neighboring states that had not expanded. It found "State Medicaid expansions to cover low-income adults were significantly associated with reduced mortality as well as improved coverage, access to care, and self-reported health."
Expanding Medicaid is a sound economic decision in Michigan, and it's the right thing to do for Michigan's citizens. Lets hope that's enough for state Republicans who have opposed the Affordable Care Act in the past.