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.

Fiscal Year 2023 State Budget Signed

capitol building

capitol buildingGov. Whitmer signed July 20 the fiscal year 2023 state budget. Included in the 2023 budget agreement is $625 million in new investments for behavioral health funding and the healthcare workforce. This includes:

  • $50 million to expand pediatric inpatient mental and behavioral health capacity throughout the state.
  • $30 million to establish crisis stabilization units for mental and behavioral healthcare.
  • $10 million to fund the essential health provider loan repayment program to cover behavioral and mental health professionals.
  • New and ongoing funding of $3.5 million to support the statewide trauma system.
  • $56 million to increase Medicaid reimbursement rates for primary care clinician services.
  • $56 million to fund the Michigan Associate Degree in Nursing to Bachelor of Science in Nursing program at community colleges across the state.

Additionally, the state budget provides the resources necessary for hospitals and health systems to continue advancing the health of individuals and communities throughout Michigan. Specifically, the budget reflects the protection or enhancement of many MHA priorities, including:

  • Maintains funding for the Healthy Michigan Plan.
  • Protects funding for the graduate medical education of physician residents.
  • Supports disproportionate share hospitals.
  • Continues funding for the rural access pool and obstetrical stabilization fund.

Each of these funding sources are instrumental to keeping hospitals financially secure, particularly those serving vulnerable and underserved populations. MHA CEO Brian Peters released a statement July 1 applauding the healthcare focus of this budget and highlighting significant investments toward rural and behavioral health. These new appropriations will allow hospitals to continue and expand upon service lines that are in increased demand due to the pandemic.

The governor also made several line-item vetoes that do not directly impact hospital priorities when signing the budget, including vetoes of funding the administration argues is anti-abortion.

Members with questions may contact Adam Carlson.

Fiscal Year 2023 State Budget Advances Health of Individuals and Communities

Brian Peters

The following statement can be attributed to Brian Peters, CEO of the Michigan Health & Hospital Association. *The budget has since been signed by Gov. Whitmer on July 20, 2022.

Brian PetersThe fiscal year 2023 state budget approved by the Michigan Legislature provides necessary resources to assist hospitals and health systems in advancing the health of individuals and communities throughout our state. We appreciate the work and consideration placed by lawmakers that continues to protect hospital priorities.

These priorities include maintaining funding for the Healthy Michigan Plan, graduate medical education of physician residents, disproportionate share hospitals which treat the highest numbers of uninsured and underinsured patients, the rural access pool and obstetrical stabilization fund, and critical access hospital reimbursement rates which all support access to healthcare services in rural areas. Each of these areas are instrumental to keeping hospitals financially secure, particularly in areas serving vulnerable and underserved populations.

We are also extremely happy to see new funding to improve and enhance state behavioral health facility capacity and to address the healthcare workforce. 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. The investment of state funds to expand access to bachelor of science in nursing degree programs at the state’s community colleges is a significant movement towards replenishing Michigan’s healthcare talent pipeline.

We look forward to a signed budget that provides the resources necessary for hospitals and health systems to care for all Michiganders.

Michigan Legislature Continues Work on Budget, Opioid Settlement Funds

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capitol buildingThe Michigan House Appropriations Committee reported out April 26 their budget recommendation for the fiscal year 2023 budget beginning Oct. 1. House Bill (HB) 5784 protects hospital priorities, including maintaining funding for the Healthy Michigan Plan, graduate medical education, disproportionate share hospitals, the rural access pool and obstetrical stabilization fund, and critical access hospital rates.

The committee recommendation also includes $264 million to expand capacity of behavioral health providers in Michigan. Of that appropriation, $85 million would be dedicated to enhancing state bed capacity for pediatric patients, $84 million would be provided to hospitals to expand various behavioral health programming, and the remainder would go toward other behavioral health care settings such as crisis stabilization units. In addition, the committee proposes increasing rates for Medicaid neonatal care services by 5%. The full House is expected to consider the committee proposals the week of May 2, and the MHA will keep members apprised of hospital budget priorities.

The full House of Representatives voted April 28 to support HBs 5968, 5969 and 5970, which would help guide Michigan’s use of new funding from the $26 billion national opioid settlement. This comes after the Senate passed identical legislation that was introduced as Senate Bills 993, 994 and 995. Either version of the bills could ultimately be sent to the governor’s desk for signature.

Michigan is estimated to receive $776 million from the settlement, and these legislative packages are intended to plan and prepare for the state to spend those funds wisely. The packages would create a new restricted fund for the state to house the settlement dollars, establish a new advisory commission appointed by the Legislature and governor to oversee spending, and prohibit future civil lawsuits related to claims covered by this fund. The MHA is currently working to identify treatment and prevention priorities for feedback on the spending of the funds and will keep members informed on the legislation’s progress.

Questions on these issues or other state legislation related to healthcare can be directed to Adam Carlson at the MHA.

Governor’s Budget Recommendation Supports Healthcare Workers, Protects Hospitals

State Budget Director Chris Harkins presents the FY 2023 executive budget.

The fiscal year (FY) 2023 executive budget recommendation was presented to the Legislature Feb. 9 by State Budget Director Chris Harkins.

The governor’s budget for the upcoming fiscal year protects key hospital priorities and includes the significant increase to outpatient Medicaid rates that took effect in October 2020. Key elements in the proposals for FY 2023 are:

  • The continuation of enhanced outpatient Medicaid rates. For FY 2022, the increase in rates is projected to result in the continuation of funding that translates to $250 million in net revenue for hospitals.
  • The executive budget recommendation protects critical access hospital funding, the rural access pool and the obstetrics stabilization fund from reductions.
  • Disproportionate share hospital payments and graduate medical education funding are also protected from reductions, continuing to reflect the MHA’s 2016 budget agreement.
  • The state’s obligation for the Healthy Michigan Plan is fully funded, and the executive recommendation continues funding for extended postpartum coverage of 12 months for new mothers who rely on Medicaid.

The executive budget recommendation also calls for additional investments in workers, education, and licensing that include:

  • $500 million of “Hero Pay” for essential workers, which includes those who were on the front lines during the pandemic.
  • $230 million for transformational educational infrastructure to improve and promote collaboration in higher education for health science and medical education.
  • $1.1 million to establish a task force and implement its recommendations dedicated to expediting and breaking down barriers to licensure for non-U.S. medical professionals

The executive budget recommendation is in addition to the $300 million for healthcare workforce recruitment, retention and training that the Legislature approved Feb. 9 (see related article). The MHA will work with lawmakers and keep members apprised as budget negotiations continue with the Legislature in the spring. As outlined in a media statement from MHA CEO Brian Peters, this was an important first step to preserve access to care in all hospitals across the state. Members with questions may contact Adam Carlson at the MHA.

Healthcare Priorities Protected, Workforce Sustainability Addressed in Executive Budget

MHA CEO Brian Peters

MHA CEO Brian PetersThe following statement can be attributed to Brian Peters, CEO of the Michigan Health & Hospital Association.

Crucial healthcare funding sources remain protected in the fiscal year 2023 executive budget recommendation. We’d like to express our gratitude toward Gov. Gretchen Whitmer and her administration for their commitment supporting rural and critical access hospitals, graduate medical education, the Healthy Michigan Plan and Michigan’s Medicaid population.

Our hospitals are also experiencing a staffing crisis that requires multiple solutions. We are thrilled to see programs that would improve retention and recruitment of healthcare workers. The proposed Hero Pay recognizes the tremendous dedication and sacrifice of healthcare workers throughout the pandemic, while the talent pipeline will be expanded through additional investments in medical education and reviewing potential licensing flexibility for foreign-trained medical professionals.

Michigan’s behavioral health system is also stressed to its limits, and we’re encouraged to see a greater focus and financial resources toward providing potentially transformational improvements to the state’s behavioral health system that can address many of the challenges patients and families currently face.

We’d be remiss if we did not thank all lawmakers and state officials who have worked tirelessly over the past two years to provide relief and support to hospitals and health systems over the course of the pandemic. As we enter another budget cycle, we look forward to continuing to engage with the Michigan Legislature to advance the health of Michigan individuals and communities.

Legislature Passes State Budget That Protects Healthcare Funding

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Michigan CapitolThe Michigan Legislature approved Sept. 22 the fiscal year (FY) 2022 state budget. The governor has indicated support for the budget that goes into effect Oct. 1, and the agreement protects vital funding sources for patient care in Michigan hospitals and expands access to healthcare services. The MHA published a statement on the passage of the budget Sept. 22.

Specifically, the budget reflects the protection or enhancement of many MHA priorities:

  • Continues enhanced outpatient Medicaid rates. For FY 2022, the increase in rates is projected to result in the continuation of funding that translates to $270 million in net revenue for hospitals.
  • Protects funding for the rural access pool and obstetrical stabilization fund.
  • Continues to maintain funding for disproportionate share hospitals (DSH) and graduate medical education (GME), pursuant to the MHA board-supported multiyear budget agreement.
  • Fully funds the Healthy Michigan Plan.
  • Continues the additional $2.35 hourly wage increase for direct care workers at skilled nursing facilities and enhanced reimbursement for ground ambulance services to reimburse at 100% of the Medicare rate.
  • Continues expanded Medicaid coverage for women up to 12 months postpartum.
  • Adds $3 million in new funding to set up a statewide system of care for stroke and ST-elevated myocardial infarction (STEMI) emergencies within the existing statewide trauma system.

In addition, nearly $10 billion in state and federal funding is still available that will be allocated through a supplemental budget process. The MHA will advocate the state use portions of the funding to address the association’s behavioral health priorities and workforce issues.

Members with questions on the state budget may contact Adam Carlson at the MHA.

MHA Statement on U.S. Supreme Court Affordable Care Act Ruling

MHA CEO Brian Peters

The following statement can be attributed to Brian Peters, CEO of the Michigan Health & Hospital Association. 

MHA CEO Brian PetersToday’s opinion issued by the U.S. Supreme Court on California v. Texas is a victory for all who believe in expanding access to healthcare. The decision upholds the Affordable Care Act (ACA) and keeps in place a system that provides health insurance to millions of Americans, access to care for millions of residents with preexisting conditions and has launched innovative models of care that have improved patients’ lives and saved billions of healthcare dollars. The success of the ACA is apparent in Michigan, as the Healthy Michigan Plan provides over 900,000 working Michiganders with comprehensive, affordable health insurance who otherwise would be uninsured.

CEO Report — Emerging from a Pandemic Program Year

MHA Rounds Report - Brian Peters, MHA CEO

Keep your face to the sunshine and you cannot see a shadow.Helen Keller

MHA CEO Brian PetersFor many years, the turning of the calendar to June has created an air of excitement as we make final preparations for our incomparable Annual Membership Meeting on Mackinac Island. While I am disappointed that the pandemic has necessitated a virtual annual meeting for the second consecutive year, new guidance from the Centers for Disease Control and Prevention and subsequent revised state guidelines have many optimistic that we have emerged from the darkest days of the COVID-19 pandemic. We know it will still be a long time before our hospitals cease caring for patients infected by COVID-19, but the increasing vaccination rates and mounting evidence documenting the reduced risk of vaccinated individuals contracting, transmitting or falling ill with COVID-19 is a sure sign that better days are ahead.

Now that we are in the home stretch of the current MHA program year (and in light of declining COVID-19 case rates, hospitalizations and test positivity rates in Michigan), I’d like to highlight several very recent non-COVID MHA accomplishments that show the strength and value of our association.

Our advocacy work never stops, and I am very pleased to share that the Michigan Legislature recently advanced budget proposals for both the current and upcoming fiscal year that fully fund our MHA priorities for hospitals and health systems. They include the Healthy Michigan Plan, which now has record enrollment levels in excess of 900,000 Michiganders; recent Medicaid outpatient rate increases; graduate medical education; the rural access pool and obstetrical stabilization fund; and disproportionate share hospital payments. In addition, the budget now includes potentially transformational behavioral health funding.

We are all too familiar with the worsening behavioral health crisis in Michigan and its significant impact on patients and families (as well as hospitals themselves). This issue has been elevated as a priority by the MHA Board of Trustees this year and, with their encouragement and support, we are pleased that the MHA team has secured inclusion in the House budget proposal for $125 million in new funding to add access to pediatric psychiatric treatment at hospitals, improve care of behavioral health patients in the emergency departments and add additional settings of care for behavioral health cases. By adding these resources, we should be able to reduce the time it takes for children to find placement, while also providing infrastructure funding for hospitals to find innovative solutions for emergency departments to improve existing facilities to accommodate patients with psychiatric needs. This may include distinct entrances for patients in crisis and separate spaces with safe furnishings and restrooms. As demand and the acuity of these patients increases, we are hopeful these funds can help address the main challenges so Michiganders can receive the treatment they need.

From an operations perspective, there has been a great deal of recent activity at the association. We recently welcomed Molly Dwyer-White, MPH, as the MHA’s new vice president of safety and quality and the MHA Keystone Center’s new executive director. Molly brings over 18 years of experience in healthcare and comes to us from Michigan Medicine, where she led multiple efforts to establish and integrate structures to assess and improve patient experience while serving as the director of the Office of Patient Experience. Molly is working closely with the MHA and MHA Keystone Center staff and governing boards as she transitions into her role, and I am confident she will continue the MHA’s strong work in improving health outcomes and addressing health inequities.

We just announced our newest MHA Service Corporation Endorsed Business Partner, CyberForce|Q, which is a leading provider of cybersecurity services, advancing the safety of information systems by utilizing a tactical, collective defense model with a focus on continuous improvement. CyberForce|Q has worked directly with the MHA for a number of years and helped us to launch our Mi|HSOC cybersecurity operations center for hospitals and health systems. With healthcare now the top target for cybercriminals globally, we are pleased to offer this new collaboration.

The MHA has also reconfigured our headquarters in Okemos, the Spencer C. Johnson Building, to allow for a new tenant in the Michigan Osteopathic Association (MOA), effective May 1. We are delighted to welcome the MOA and its members to our facility, and we are confident that this arrangement will lead to even greater opportunities for synergy well into the future. Both of our organizations, along with the Michigan State Medical Society, comprise The Partnership for Michigan’s Health, which routinely produces the Economic Impact of Healthcare in Michigan report, and collaborates on efforts that improve Michigan healthcare.

As for those MHA employees housed in the MHA headquarters and our Capitol Advocacy Center in downtown Lansing, their contributions and insights have helped the MHA make Modern Healthcare’s list of Best Places to Work in Healthcare for 2021 — the only state hospital association to be recognized. I am incredibly proud of this prestigious distinction because it validates our constant efforts to support our employees — who are the strength of our association. To earn this distinction in the midst of a pandemic is especially gratifying.

I also want to recognize our outgoing Board Chair Edwin A. Ness, president & CEO of Munson Healthcare, whose term will end later this month. Taking the gavel amid a once-in-a-century pandemic, Ed provided tremendous leadership to help guide us through multiple statewide COVID-19 surges and the challenges associated with the delivery of safe and effective COVID-19 vaccines. We spent many early mornings and late nights on phone calls, and the MHA could not have accomplished what we did without Ed’s unwavering commitment to the role.

During Annual Meeting, we will formally transition from Ed to incoming Board Chair Tina Freese Decker, president & CEO of Spectrum Health, who I could not be more excited to lead us through our next program year. In addition to guiding West Michigan’s largest health system, Tina has played an active role as a co-chair with the Protect Michigan Commission in addressing vaccine hesitancy and increasing education and awareness efforts on the safety and effectiveness of the COVID-19 vaccines.

If you have not done so already, I encourage you to register and join us at Annual Meeting. In addition to hearing Tina’s formal remarks, I’m particularly happy to have my friend Rick Pollack, president and CEO of the American Hospital Association, scheduled to join us to discuss key healthcare advocacy items at the federal level. We will also be joined by Kevin Ahmaad Jenkins, a leader in health equity who serves as a fellow within the Veterans Health Administration’s Office of Minority Health and will explore racism and its effect on public health, as well as breaking social stigmas relating to racial injustice in healthcare.

While the 2020-2021 program year has been one of the most difficult in recent memory, I am proud of the strength and resiliency displayed by the MHA, our employees, our member organizations and the front-line caregivers who have gone to war against the COVID-19 virus every day. We are not out of the woods yet by any means, as we must be mindful of potential emerging variants and other complicating factors that could lead to yet another future surge. Rest assured that the MHA will continue our daily efforts in support of our members until COVID-19 is defeated once and for all. In the meantime, we should collectively celebrate the fact that, at least for now, new infections and hospitalizations have been dramatically reduced.

Through it all, the MHA has continued to serve our members and live our mission to advance the health of individuals and communities, to innovate and to keep an eye to the future. I am pleased to share just a few tangible examples in this column, and I am optimistic about our ability to create even more successful outcomes in the future. In short, we have kept our collective faces to the sunshine and, as a result, our association is as strong as ever.

As always, I welcome your thoughts.

CEO Report – Protecting the Financial Health of Hospitals

MHA Rounds Report - Brian Peters, MHA CEO

“Annual income twenty pounds, annual expenditure nineteen six, result happiness. Annual income twenty pounds, annual expenditure twenty pound ought and six, result misery.”Charles Dickens

MHA CEO Brian PetersThe past year has been extremely challenging for everyone across the globe. At the very top of that list: those who have lost loved ones to the pandemic, and those who have suffered from the often severe health consequences associated with COVID-19. At the same time, the financial blow to hotels, restaurants, bars, entertainment venues, and countless other businesses large and small has been well documented. And we all know about the mental health concerns brought about by income and job loss, the need for remote learning for students and the resulting lack of socialization, plus a host of other consequences that have accompanied this pandemic and negatively impacted people for many, many months now.

As a Michigander and a father, I care deeply about all of this. And as the CEO of the Michigan Health & Hospital Association, I have the great privilege of getting to do something about it every single day. After all, our very mission is to “advance the health of individuals and communities.” It is from this perspective that I can tell you how proud I am of our member hospitals and health systems throughout the state — and how concerned I am for the wellbeing of our caregivers and staff, and for the financial viability of the organizations themselves as the dark cloud of the pandemic continues to hover over all of us. Am I biased? Perhaps. But I truly believe that hospitals must be supported and protected at this time more than ever, for the betterment of our entire society.

Our members have now been serving on the front lines for over a year and have experienced significant physical and mental trauma. For those institutions that serve our local communities and employ our healthcare heroes, the last year has also been filled with financial uncertainty at best, and devastation at worst. Early in the pandemic, when elective procedures came to an abrupt halt, the double-edged sword of new, unbudgeted expenses related to ramping up to deal with COVID-19 combined with lost volume and revenue on an order of magnitude that we have never seen in modern times, pummeled our hospitals and health systems financially. For even our largest members, furloughs and layoffs became necessary.  And for our smaller, independent or rural hospitals, there were legitimate concerns about keeping the doors open in the face of severe cash flow disruptions.

Just one example of new costs: personal protective equipment (PPE) is a term Americans became all too familiar with last year. Our hospital supply chain leaders can verify that increasing the number of gloves, gowns, respirators, masks and face shields, both for immediate use and for the “new normal” stockpile requirements, is not only more expensive due to sheer quantity, but the prices have soared due to increased demand. To avoid dependence on the global supply chain, many organizations are now diversifying their network of suppliers and contracting with domestic companies. However, doing so comes at a cost, as domestic production is typically more expensive. This is just one of many factors that have driven hospital total expense per adjusted discharge higher by 19.6% over the past year, according to a recent analysis of national data from Kaufman Hall. Our own data and anecdotal evidence show that Michigan closely mirrors this trend.

Coupled with increased expenses is decreased revenue, as total patient volume has yet to recover to pre-pandemic levels. The same analysis from Kaufman Hall found that overall revenue (not including federal aid from the Provider Relief Fund) fell 4.6%, with emergency department visits decreasing 26.8%. As part of surge planning, hospitals have been forced to delay many nonemergency medical procedures.  Unfortunately, images of hospitals admitting COVID-19 patients and constructing temporary outdoor facilities also created a misplaced fear among a subset of the public that hospitals were no longer safe places of care. Much work, at both the state and federal level, has gone into correcting this misconception, but there remains a significant number of people who have legitimate healthcare needs who are still delaying care — to their own detriment. The resulting drop in patient volume and procedures has created a gap in hospital revenue that will take a long time to recover.

Lastly, the insurance coverage mix is also continuing to change for the patients utilizing our hospitals, specifically moving toward government programs or no coverage at all. According to the National Center for Coverage Innovation, Michigan had the sixth highest increase in newly uninsured adults, with 222,000 individuals becoming uninsured due to job losses, representing a 46% increase from 2018 levels. We’ve seen the growth borne out in the Healthy Michigan Plan (HMP), our state’s Medicaid expansion program, which has seen enrollment increase from a pre-pandemic level of approximately 650,000 beneficiaries to nearly 900,000 today. While continued coverage for all Michiganders is a top MHA priority, and we are incredibly thankful for the existence of the HMP, this transition from employer-sponsored health plans to government healthcare programs means more patient care is being reimbursed at a lower rate in contrast to the full cost of care.

To directly address all these challenges, the MHA has advocated strenuously for financial relief at the state and federal levels, and our members have been incredibly grateful for it. Federal funds such as the CARES Act helped to alleviate the immediate crisis, while providing a measure of financial stability to all hospitals (and serving as a real lifesaver for some). We have successfully delivered accelerated payments, targeted loans and grants, and more. One item of important relief that was implemented at the beginning of the pandemic was a moratorium on Medicare sequestration, the scheduled 2% cut to all Medicare payments that would have been a significant financial hit to hospitals and health systems at the worst possible time. Recently, legislation that delays these cuts through the end of the year passed the Senate with a bipartisan vote (thank you to our U.S. Sens. Debbie Stabenow and Gary Peters, for their support) and is expected to pass the House of Representatives once Congress returns from Easter recess. All of this is helpful — but none of this is a long-term solution to guarantee the financial viability of hospitals. Our members (even pre-pandemic) are doing their part to be innovative and increasingly focused on cost-effectiveness. But they need our continued support.

There is cause for optimism as we head down the road to recovery. Today, all adults 16 years and older are eligible to receive the COVID-19 vaccine in Michigan. Vaccine supply, which has increased dramatically in recent weeks, is expected to expand in the weeks ahead. In fact, we are very close to the day where the supply and demand curve flips and our efforts will need to focus on reaching vaccine-hesitant populations. The reasons to receive the safe and effective vaccines are many, as most importantly they prevent hospitalization and death and protect loved ones and those around you from contracting the disease. There is no better evidence than recent data the MHA released that shows hospitalizations are increasing the slowest among the age cohorts that have a higher percentage of vaccination.

Collectively, achieving our state’s goal of vaccinating 70% of the population allows our financial recovery to truly begin. To return to some sense of normal, everyone must do their part to mitigate the chance of future outbreaks. That tool is in our toolbox and it starts by scheduling a vaccine appointment. From there, restrictions and protocols placed on in-person office work, education instruction, and entertainment and leisure activities can be lifted. But we cannot trick ourselves into thinking that we can do all these things without reaching our vaccine goals first.

As Michigan hospitals deal with a legitimate third surge of COVID-19 patients, it takes everyone to do their part to put our state and communities on a path to recovery. By doing the right things, practicing preventive measures such as wearing a mask, social distancing, washing your hands and receiving a vaccine, we can protect both our physical health and the financial health of our hospitals that operate 24/7/365 to provide care when we need it. After all, the same hospitals that are needed to fight COVID-19 today are the hospitals that will be needed to treat auto accident victims, cancer patients and countless other loved ones in the future. They deserve our full support.

As always, I welcome your thoughts.