This man has power over 1 in 5 Mich. lives

Stephen Fitton has a corner office on the top floor of a state office building in Lansing, which is perhaps fitting for the person who directs the second-most expensive program in Michigan government

To be clear, the corner office, like the man who inhabits it, is far from ostentatious.

Fitton has plenty of windows -- and plenty of  Michigan State University memorabilia, including a small model of Spartan stadium in the center of a round table where he meets with guests. Those personal touches compete with piles of papers and a strangely large collection of cheap pens that Fitton acknowledges tossing in the center of the table.

The office's decor is government-issue, leavened by a joke book and a large number of empty Coca Cola containers -- evidence of a habit Fitton insists he's curtailing.

As director of the Medical Services Administration in the Department of Community Health, Fitton has one of the largest jobs in all of state government. His brief is Medicaid, which now provides health care services to more than 1.9 million people -- nearly 20 percent of the entire state. Since 2006 alone, Michigan's Medicaid ranks have swelled by nearly 500,000 people -- another consequence of the state's "Great Recession."

Fitton and his staff are supposed to make sure some $10 billion in state and federal money is used properly; only Michigan's spending on K-12 education exceeds the sums committed to Medicaid.

Bespectacled, Fitton has graying hair and an even, flat, slightly nasal voice. Seen at legislative meetings and public hearings, where often sorrowful personal testimony on patients who are poor as well as seriously physically and mentally impaired makes for wrenching listening, Fitton maintains an even demeanor. He is approachable, but cautious, recognizing his requirements to balance two equally pressing demands: provide sometimes life-saving service to the poor who have no other source of health-care coverage, while making sure it is done in the most cost-efficient manner for the taxpayers.

Ironically, that balancing act echoes two elements of his early life: Fitton was a preacher’s kid from Davison who both thought about the ministry himself, and but who had an early interest in mathematics.

Fitton is also a lifer with the state, joining public service straight out of college. Virtually his entire career has been in health and social services.

“No state employee works independently,” Fitton said. “We have a great staff here.

In fact, Fitton said he is “sobered by all the people involved” in the process of administering Medicaid.

Because the “scope of (Medicaid) has really jumped,” the overall size of the Medicaid administrative staff has almost doubled over the years, Fitton explained.

Jan Hudson, senior policy advisor for the Michigan League for Human Services and chair of the Medical Care Advisory Committee (which meets with Fitton) said Fitton, 61, is not just a numbers guy.

“He cares for the people he serves, and that’s a good thing,” she said.  He has gone so far as to help individual clients who having some problems with the system, she said.

Fitton said managing Medicaid involves balancing instinctual attitudes: No. 1, a sense that people should be responsible for their health care, but that they are entitled to medical care; and, No. 2,, an attitude that people don’t want to spend too much money. And it has to be done within a political atmosphere.

Moreover, it has to be done during a “time of momentous change in health care,” Mr. Fitton said. Part of that is due to the 2010 Affordable Care Act (called Obamacare by its critics), but it also has to do with treatment changes, new pharmaceuticals, research into diseases and the law.

If ACA survives a challenge before the Supreme Court, under its provisions an estimated 500,000 more people in Michigan will be eligible for Medicaid, Fitton said. That in itself is just one example of the enormous potential changes facing Medicaid and healthcare overall.

Given its overall role and its part in ongoing controversy on government entitlements and cost control, Fitton said there is a “real business case to be made for Medicaid.” If Medicaid, which heavily subsidized by the federal government, ends, the burden for providing funding for overall care and to keep the health-care system intact would likely switch to business, he said.

Fitton jokes that besides his interest in sports, his wife, Victoria, and three sons nag him that he really has no hobbies.

Fitton was eligible to take early retirement in both of the last two early retirement options the state provided, but has chosen to remain in public service.

“This is the best job I’ve ever had,” he said. “You’re able to do good things for people. And there are great people who work here. I’m not ready to retire.”

John Lindstrom is publisher of Gongwer News Service Michigan, a subscription service that covers daily activities at the Capitol and in state government. Lindstrom is a graduate of Michigan State University and has worked in Michigan journalism for more than three decades.

Editor's note: This story was produced in a collaboration between Bridge Magazine and the Gongwer News Service, www.gongwer.com.