Michigan very nearly was the first Republican-led state to create its own health insurance exchange. By November 2012, legislation to create an exchange had passed the Michigan Senate and was supported by Governor Snyder and the Speaker of the House. A broad coalition of interest groups lobbied in favor of a state-based exchange, including insurers, businesses, providers, hospitals, and consumer advocates. They were opposed by passionate Tea Party leaders using “targeted activism” to make their presence felt. As in Mississippi, they were supported by national and state conservative think tank organizations. Opponents at the last minute attached an abortion amendment to the key bill and the House Health Policy Committee voted down authorizing legislation in November 2012, killing the possibility of a Michigan-run exchange. Governor Snyder tried to establish a partnership exchange but was blocked by the legislature refusing to appropriate money the state had been promised in federal grants.
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