“I pass my life in preventing the storm from blowing down the tent, and I drive in the pegs as fast as they are pulled up.” — Abraham Lincoln
You may have seen recent media coverage noting that the MHA is joining efforts to address and reform Michigan’s auto no-fault insurance law. The reality is our efforts to protect and preserve what we viewed as the best system in the nation for ensuring access to care for auto accident victims dates back decades. Despite those efforts, in 2019, we clearly understood that the political stars were aligning in such a way that substantial reforms were imminent and, hence, our work in the months and years since has pivoted.
I am proud that we led an effort to assist consumers in making educated purchasing decisions in light of those 2019 reforms, and we are pleased that most Michigan drivers to date have seen the wisdom in continuing to purchase unlimited coverage to protect themselves and their families in the event of a catastrophic accident. While this effort was intended to be very visible to the public, some of our other efforts have played out behind the scenes and relate to the regulatory aspects of the new law that impact how hospitals and other care providers are compensated for the important services rendered to accident victims.
The changes to reimbursement that went into effect last July created several significant difficulties for hospitals. In effect, the new law created price controls, something we argued is never a good idea because they inevitably create real inequities. Throughout the no-fault debate, we have argued hospitals and other providers need to be fairly compensated to ensure we have the physical space, the technologies, the staffing expertise, and everything else that is necessary to provide care in the hospital emergency department, intensive care units and in the venues that provide rehabilitative and attendant care. Every step of that process is very important for the physical, mental, and fiscal health and well-being of those auto accident victims and their families.
The impact on post-acute facilities has already been well publicized, as reimbursement inequities are leaving many to reduce their patient load or close their doors entirely. While most of these patients have no immediate needs that require hospitalization, the lack of available alternatives means they increasingly have nowhere else to go; some patients are now being transferred to hospitals at a time when we are short staffed and operating at high capacity. Emerging from yet another COVID-19 surge, hospitals need every available bed for patients requiring acute hospital care.
Also impacting hospitals has been a lack of consistency in payment rates and confusion on payment limitations. Claims processing from insurers has been significantly delayed, and there are serious inconsistencies in reimbursement rates across payers due to confusion over Medicare rates. The definitions from the law passed in 2019 are insufficient, and additional clarity is needed to ensure reimbursement rates are accurate and consistent with the intent of the law. The MHA has spent much time working with the Department of Insurance and Financial Services on the need for a proper definition of Medicare rates to address this problem. The payment inadequacy, discrepancies and delays are at odds with the negotiations that occurred in 2019 and the intent of the law. The law was designed to reduce the cost of auto insurance. Instead, it is creating an unfair and unstable system of reimbursement and threatening access to certain types of patient care.
Many hospitals across Michigan operate on razor thin patient care margins and have done so for many years. In fairness to all involved, when the auto no-fault reform legislation was signed into law back in 2019, no one could have foreseen an impending pandemic and the unprecedented financial stress it would impose on hospitals and the entire healthcare ecosystem. But we clearly see the reality of the situation now.
The MHA is fully supportive of reforms that will address our concerns. It is often said that “politics is the art of the possible.” We will continue to do all that we can to advocate for public policy that ensures access to much-needed care, in the context of a challenging political environment.
On that note, I would be remiss if I didn’t thank the governor, as well as Republicans and Democrats in the state Legislature, for their bipartisan support of House Bill 5523, which will deliver critically needed funding support to address our healthcare workforce crisis. Our elected officials came together and got it right. When it comes to our auto no-fault system, I am optimistic that we will ultimately make things right as well.
As always, I welcome your thoughts.