Auto No-Fault Legislation Highlights Healthcare Activity in Michigan Legislature

capitol building

capitol buildingSenate Bills (SBs) 530 and 531 were introduced Sept. 26 by Sen. Mary Cavanagh (D-Redford Twp.) and Sen. Sarah Anthony (D-Lansing) that would adjust the hospital fee schedule, clarify the definition of Medicare and provide rate certainty for post-acute care providers. Specifically, the legislation would eliminate the various rate tiers for reimbursement and coalesce hospitals around the national median reimbursement rate of 250% of Medicare. Additionally, the legislation clarifies the definition of Medicare based upon actual reimbursement experience at hospitals. The MHA issued a media statement in support of the legislation, which also creates fee schedules for post-acute care providers and adjusts the provisions related to attendant care. The legislation is referred to the Senate Insurance Committee and the MHA will keep members updated on its progress.

The legislature continued its breakneck pace this week with numerous healthcare bills seeing both committee action.

The Senate Finance, Insurance and Consumer Protection Committee voted out SBs 483, 484 and 485 sponsored by Sen. Darrin Camilleri (D-Trenton), Sen. Veronica Klinefelt (D-Eastpointe) and Sen. Kristen McDonald Rivet (D-Bay City). The legislation, creating the Prescription Drug Affordability Board, was reported along party lines with Senator Mark Huizenga (R-Walker) passing based on a potential conflict of interest. The MHA continues to work with the sponsors, stakeholder, and leadership on this legislation to ensure it accurately reflects the important role hospitals serve as purchasers and administrators of prescription drugs. The MHA is opposed to the package as it is currently written.

The Senate Health Policy Committee took up SB 133, sponsored by Sen. Sean McCann (D-Kalamazoo), which creates the Overdose Fatality Review Act. The act would allow for the establishment of overdose fatality review teams to identify potential causes of drug overdoses, as well as recommend solutions to address drug overdoses. The MHA successfully recommended changes to reflect more appropriate information sharing practices and timelines and supports this legislation. In addition, the committee reported out House Bills (HBs) 4619, 4620, 4621, 4622 and 4623, codifying aspects of the Affordable Care Act in state law. The MHA supports this work.

The House Insurance and Financial Services Committee took up several of the Affordable Care Act codification bills including SBs 356, 357 and 358 sponsored by Sen. Kevin Hertel (D-St. Clair Shores), Sen. Mary Cavanagh (D-Redford Twp.) and Sen. Veronica Klinefelt (D-Eastpointe). Both SBs 356 and 357 failed to garner enough votes in committee to be voted out of committee. SB 358 was reported to the House Floor. The MHA supports this legislation and looks forward to seeing the remaining bills reported favorably to the House floor next week.

Finally, the House Health Policy Committee took testimony on two pieces of MHA supported legislation. HB 4101, sponsored by Rep. Curt VanderWall (R-Ludington), would allow for the issuance and extended renewal period of a temporary license for individuals completing their required supervised clinical hours as a speech language pathologist (SLP). Extending the timeline for supervised clinical hour completion will deter new graduates from leaving the state to complete their supervised hours and will assist in the retention of SLPs in Michigan.

SB 384, sponsored by Sen. Kevin Hertel (D-St. Clair Shores), prohibits a disability insurer, long term care insurer or life insurer from discriminating against an individual based on their status as a living organ donor. Individuals who choose to be a living organ donor must meet stringent requirements and many of those who do donate continue to live similarly healthy lives post donation. However, the possibility of discrimination could deter individuals from choosing to be a living donor and therefore limiting access to organs for those most in need. Prohibiting discrimination based on living donor status could increase organ availability, ultimately supporting opportunities for individuals in need of an organ transplant.

Members with questions about state legislative action may contact Adam Carlson at the MHA.

MHA CEO Report — A Healthy Michigan is an Insured Michigan

MHA Rounds Report - Brian Peters, MHA CEO

“Life is what happens while you are busy making other plans.” — John Lennon

MHA Rounds Report - Brian Peters, MHA CEOThe United States celebrated last month the 13th anniversary of the signing of the Affordable Care Act (ACA). Simply put, when then-President Obama signed the legislation March 23, 2010, it was one of the most monumental healthcare policy changes in our lifetime. Since its passage, it has provided millions of Americans with health insurance, provided access to care for millions of residents with preexisting conditions and incentivized the launch of innovative models of care that have improved patients’ lives and saved billions of healthcare dollars.

The MHA was pleased to celebrate the anniversary by having MHA Executive Vice President Laura Appel join U.S. Rep. Elissa Slotkin and others in a virtual press conference discussing the positive impact the ACA has had on Michiganders.

The mission of the MHA is to “advance the health of individuals and communities.”  We have long supported the ACA, as the availability of robust health insurance coverage is crucial to achieving this mission. The benefits of the ACA can be measured by the more than one million Michiganders now covered by our Medicaid expansion program – the Healthy Michigan Plan – and more than 320,000 Michiganders who now receive coverage through the Health Insurance Marketplace created simultaneously by the act. Combined, these new developments have helped to significantly reduce the number of uninsured individuals in Michigan, which consistently numbered well over one million people in the years prior to the ACA’s passage.

The history of health insurance coverage in America is interesting and complex, and there were two major turning points in the 20th century that preceded the ACA. First, to combat inflation amid World War II, Congress passed the 1942 Stabilization Act. Designed to limit the ability to raise wages, the act led employers to instead offer health benefits for the very first time. Because health benefits did not count as income, they were not taxable to the employees. With a flip of the proverbial switch, employers were in the health insurance business and have never looked back. Second, in 1965 then-President Lyndon B. Johnson signed into law the enabling legislation to create the Medicare and Medicaid programs, which have provided coverage to important populations including seniors, those with disabilities, low-income and more.

Today the majority of Michiganders – over six million – are covered by employer-sponsored private insurance. But both Medicare and Medicaid have grown, accounting for approximately two million enrollees in each program respectively.  This growth is driven by different factors: for Medicare, we obviously have an aging population, increasingly fueled by the baby-boom generation. And for Medicaid, we have seen both organic growth in the traditional program, as well as significant growth in the Medicaid expansion program.

Whether public or private, we celebrate health insurance coverage because it directly benefits people, as they are more likely to see a primary care practitioner, seek recommended tests and screenings, receive appropriate prenatal care and generally access a wide array of healthcare services in such a way that their issues can be identified and resolved as early as possible. Not only does this mean better outcomes, but it also saves healthcare costs in the long run. And of course, having insurance coverage provides financial peace of mind for families when an unanticipated serious illness or catastrophic injury occurs.

The truth is that better insurance coverage is a positive for hospitals as well, as it helps to reduce the amount of uncompensated care that we must absorb. However, simply having an insurance card is no guarantee that an individual will have the appropriate level of coverage, as the rise in high-deductible and “skinny” insurance plans still result in significant and growing out-of-pocket expenses for consumers. These plans in turn have created more bad debt and uncompensated care for hospitals because consumers often purchase these plans based strictly on price without full knowledge of their co-pays, deductibles, which providers are considered in-network and what care may not be covered at all. On this note, the subject of surprise medical bills has been in the spotlight in recent years, culminating with the implementation of the federal No Surprises Act in January 2022. There is no doubt hospitals own our share of this issue – and we are committed to doing all we can to improve. But as a wise health policy observer commented to me at the time, the situation for far too many Americans can be summarized as “surprise, your health insurance stinks.” The total unpaid costs of patient care for Michigan hospitals in 2020 exceeded $3.4 billion, and the anecdotal evidence points to this challenge continuing ever since.

Back to the public policy front, one key issue on our radar screen now is the pending expiration of the COVID-19 public health emergency (PHE). Michigan has an additional 355,000 residents enrolled in traditional Medicaid and 367,000 additional Healthy Michigan Plan enrollees since the PHE began, and many of them will be at risk of losing coverage when the PHE ends and the Medicaid “redetermination” process begins.

In many Michigan counties, more than 30% of the population uses Medicaid for its healthcare benefit. The goal of the MHA and our partner stakeholder groups is to work with the Michigan Department of Health and Human Services (MDHHS) to ensure as many people as possible either maintain their Medicaid coverage or transition to an appropriate plan on the insurance exchange if they do not now have employer-sponsored coverage. This will continue to ensure that community members avoid interruptions in their care and will allow us to maintain many of the health outcome gains achieved over the past 13 years.

The MDHHS has created tools and resources for providers and partners aimed at educating their patients about the need to ensure their contact information is updated so they properly process their redetermination paperwork. The MHA has worked closely with our member hospitals and health systems to share these resources. This may be the first time for many beneficiaries that they must renew their coverage, and some may not even be aware they’re on Medicaid. Hospitals are the main touchpoint for many beneficiaries and hence play a very significant role in helping to facilitate this process for vulnerable patients.

The ACA, like any other major public policy change, has been far from perfect. But reflecting on the success in providing coverage to more Michiganders, we must express our gratitude for those at both the federal and state levels for the gains we’ve made over the past 13 years. In Michigan, we’ve received bipartisan support over the years for expanded coverage. Despite all the challenges hospitals and health systems have experienced in recent years, the gains made from the ACA have been a big reason why Michigan hospitals can continue to serve their communities throughout all areas of the state.

And on the broader issue of health insurance coverage, we would be remiss if we did not acknowledge that insurance is only one element that contributes to – but does not on its own ensure – access to care. Our efforts in the health equity domain have shown clearly that language and cultural barriers, transportation, housing, food insecurity and many other factors contribute to the ability of many Michiganders to get the care they need. But at the end of the day, having insurance is a critically important first step. No one plans to get sick or injured – but when “life” happens, that coverage is nothing short of a blessing.

As always, I welcome your thoughts.

MHA Celebrates ACA Anniversary with Congresswoman Slotkin

Speakers of the Protect Our Care press conference.
Laura Appel speaks during a press conference on the 13th anniversary of the Affordable Care Act.
Laura Appel speaks during a press conference on the 13th anniversary of the Affordable Care Act.

MHA Executive Vice President Laura Appel joined U.S. Rep. Elissa Slotkin and other healthcare advocates March 23 as part of a virtual press conference organized by Protect Our Care to celebrate the 13th anniversary of the Affordable Care Act (ACA).

Appel emphasized the MHA’s long-standing support of the ACA and Michigan’s Medicaid expansion through the Healthy Michigan Plan, which provided millions of Americans with health insurance, provided access to care for millions of residents with preexisting conditions and saved billions of healthcare dollars. More than one million Healthy Michigan Plan beneficiaries are currently covered by Michigan’s Medicaid expansion program allowed by the ACA and more than 320,000 Michiganders receive coverage through the Health Insurance Marketplace created by the ACA. Appel also referenced the $10 billion reduction in Medicare payments that Michigan hospitals committed to experience in order to ensure state residents have access to expanded health insurance coverage under the ACA.

Additional speakers during the press conference included Laura Bonnell, CEO of the Bonnell Foundation, and Sarah Stark, a Type 1 diabetic who benefitted from the original ACA expansion.

Media representatives from The Detroit News, WWJ Newsradio 950, WOOD TV8 and WLNS-TV joined the press conference.

A press release was published following the conclusion of the press conference by Protect Our Care and a recording of the press conference is available on the Protect Our Care Michigan Facebook page.

MHA CEO Report — Benefits of the State Budget

MHA Rounds Report - Brian Peters, MHA CEO

MHA Rounds Report - Brian Peters, MHA CEO“We must find time to stop and thank the people who make a difference in our lives.” ― John F. Kennedy

We have rightfully spent a lot of time in the past two years thanking the heroes who work in our hospitals and other healthcare settings for the incredible work they have done in the face of extreme challenge.

I want to take a moment now to thank another group of people who have recently helped our cause through their bipartisan actions; our elected officials in Lansing were extremely busy the last week of June passing the fiscal year 2023 state budget, which has since been signed by Gov. Whitmer. Our MHA mission is to advance the health of individuals and communities — and this budget absolutely provides significant help in that regard. While some elements of the new budget represent long-standing MHA priorities, others are new funding items that have the potential to reshape access to care and help our members and the patients and communities they serve.

Our MHA team does a tremendous job advocating for the importance of items such as the Healthy Michigan Plan, graduate medical education of physician residents, disproportionate share hospital funding, maximization of our robust provider tax program and Medicaid payment rates, the rural access pool and obstetrical stabilization fund, and critical access hospital reimbursement rates. Every election cycle, new legislators are welcomed to Lansing and the MHA’s efforts never stop to ensure these decisionmakers are aware of the impact these budget items play in their communities. The bottom line is the financial viability of hospitals is increasingly reliant on these important programs, and the MHA is dedicated to protecting them.

Hospital closures continue to happen across the country. However, they have occurred at a much higher rate in states that have not participated in Medicaid expansion through the Affordable Care Act. Maintaining funding for our expansion program — the Healthy Michigan Plan — has been one of our top priorities, and the pandemic has made the importance of insurance coverage more important than ever. In short, when the pandemic hit and thousands of Michiganders lost their jobs, the Healthy Michigan Plan was there to ensure access to good healthcare.

Our hospitals that treat the highest numbers of uninsured and underinsured patients also qualify for disproportionate share hospital funding, which provides enhanced reimbursement to account for the higher costs of care. This pool is funded through hospital provider taxes that reduce the state’s general fund contribution to the overall Medicaid program.

Small, rural and independent hospitals can often experience financial challenges in a particularly acute way, thus items such as the rural access pool, obstetrical stabilization fund and critical access hospital reimbursement rates also support access to healthcare services in rural areas. Labor and delivery units typically do not contribute to positive margins, but they are extremely important for families and communities. The obstetrical stabilization fund provides additional means for hospitals in rural areas to maintain these services so expectant mothers can avoid driving exorbitant distances for these services. Lastly, the state also included $56 million in new funding to increase Medicaid reimbursement rates for primary care services, which will help individuals on Medicaid receive the necessary primary and preventative care that can help prevent hospitalizations and reduce overall healthcare costs.

The top concern of hospital leaders remains workforce sustainability, and the continued funding for graduate medical education is one tool we must continue to use to maintain the physician talent pipeline that is sorely needed. At the same time, we are extremely happy to see inclusion of state funds to expand access to Bachelor of Science in Nursing degree programs at the state’s community colleges to help address the nurse talent pipeline, a $56 million line item. This proposal was supported by the MHA when it was formally introduced, and we look forward to seeing our post-secondary partners implement it to grow the healthcare workforce.

Lastly, behavioral health investments have been at the forefront of our advocacy efforts for some time and we were very pleased to see new funding to improve and enhance state behavioral health facility capacity. Michigan lacks adequate capacity to treat patients with behavioral and mental illness and this new funding is an important and necessary step to address the shortage. Included is $50 million to expand pediatric inpatient behavioral health capacity, $30 million to establish crisis stabilization units and $10 million to fund the essential health provider loan repayment program to cover behavioral health professionals.

In total, the budget includes $625 million in new investments for behavioral health funding and investments in workforce. While this will not solve all the issues impacting hospitals, it provides needed resources and demonstrates the commitment of lawmakers to a healthy Michigan. This budget also signifies that our work must continue to advocate for the resources necessary for hospitals and health systems to care for all Michiganders. Once again, on behalf of the entire MHA family, I want to acknowledge and thank both Governor Whitmer, as well as lawmakers in the state House and Senate, for their support of this latest state budget. And I would also encourage anyone who cares about access to quality, affordable healthcare to engage in the process, share your stories and input with those who can make a difference going forward. But also remember to say thank you when they support our cause.

As always, I welcome your thoughts.