MHA CEO Report — Sustaining Hospital Funding is Key to Meaningful Reform

MHA Rounds image of Brian Peters

“We can’t become what we need to be by remaining what we are.”  — Oprah Winfrey

Michiganders heard a clear message from our state and federal leaders last week: healthcare is too expensive and the system is flawed. We agree. Michigan hospitals are deeply invested in providing timely and accessible care, reducing unnecessary administrative burden and improving transparency.MHA Rounds graphic of Brian Peters

The healthcare landscape in our country is incredibly complex, so it’s imperative to recognize no single action or one-size-fits all approach will create the substantial change we need. For decades, good-faith, reactive polices have attempted to manufacture financial stability for patients and providers by addressing immediate cost pressures, but this approach has only delayed the inevitable conversations we must have about healthcare affordability and sustainability.

Michigan hospitals continue to experience reimbursement rates that fall far below the cost of providing care and our patient population is simultaneously growing older and sicker. Hospitals are continually being asked to do more with less, but even their most innovative efficiency efforts cannot overcome reimbursement that lags far behind the growing cost and complexity of patient care. For example, general inflation rose by 14.1% from 2022 to 2024, while Medicare net inpatient payment rates increased by only 5.1% during the same time period. Access to important healthcare services is at risk when providers are reimbursed at less than the cost of care.

We’re eager to discuss long-term solutions with employers, lawmakers and other healthcare stakeholders, but we cannot address these systemic issues from our back foot. Labor, drug and supply costs are forcing hospitals, especially those in rural areas of the state, to limit services. Maintaining healthcare funding is about protecting access to care in communities across Michigan and not about preserving the status quo.

To create a more affordable system, we need one that is strong enough to withstand change. If we can pair reform and sustainability actions, we can strengthen care and lower costs for everyone long-term.

As always, I welcome your thoughts.

MHA CEO Report — The Reality Behind a Hospital Ribbon-Cutting

MHA Rounds graphic of Brian Peters

MHA Rounds graphic of Brian Peters

Hospital ribbon-cutting ceremonies tend to spotlight the new and modern elements of a hospital expansion: bright windows, sleek patient rooms or advanced diagnostic technology. But what you don’t see is often more important than what you do.

Behind nearly every new facility is a story of aging infrastructure, outdated equipment and community needs that have outgrown what a hospital’s existing buildings can provide. Many hospitals operate buildings that are decades old – some built long before today’s medical technology, infection control standards or patient-centered design principles even existed.

Aging facilities often have electrical systems that can’t support modern equipment, rooms that limit the physical safety and efficiency of frontline workers, HVAC systems not suitable for infection control, or layouts that slow down emergency response or patient flow. Hospitals replace facilities because community needs can no longer be met with outdated structures, not because they want something new.

Expansion of facilities or technology, also referred to as capital projects, are funded through a mix of sources. These often include donors and philanthropic gifts, grants from foundations or government programs, bond financing, occasional state or federal appropriations and hospital capital budgets, which are built from small operating margins over the course of multiple years. These new facilities are not paid for directly from patient bills.

Even in years when hospitals have positive margins, these average margins are typically around only one to three percent and are reinvested directly back into patient care, safety improvements and facility upgrades. These reinvestments in new construction are about preserving access and modernizing care; not profit.

New buildings or service lines often emerge because patients travel long distances for essential care, equipment is too outdated to repair, demand for services like cancer care, imaging or behavioral health has grown, or because safety standards require major updates. A hospital that upgrades its cancer center or brings 3D digital mammography closer to home is reducing travel burdens, improving outcomes and keeping care local.

Behind Every Ribbon are Years of Work and Analysis

Before any groundbreaking, hospitals spend years evaluating whether renovation is possible or if replacement is more cost-effective. Hospitals also consider how to minimize disruption to patient care and what community health data shows about long-term needs. Finally, with all those factors considered, hospitals and health systems then determine how to secure funding without burdening patients.

The result may look like a brand-new facility, but it represents years of planning, prudent budgeting and community-focused decision-making.

In an era when headlines move fast, communities may question why hospitals announce expansions at the same time they face workforce shortages or reimbursement challenges. The answer is simple: capital investments and operational budgets are not the same.

A hospital can be financially strained day to day while still needing to replace unsafe or outdated infrastructure. So next time you see your local hospital celebrating the grand opening or ribbon cutting of a new facility or technology, you can join in the celebration by knowing that your community, family and friends are receiving high-quality, modern care for decades to come, all close to home.

As always, I welcome your thoughts.

MHA Monday Report Jan. 12, 2026

MHA Healthcare Leadership Academy Applications Due Feb. 6

The enrollment deadline for the MHA Healthcare Leadership Academy is Feb. 6. The cohort meets Feb. 25-27 and May 7-8 at the MHA headquarters in Okemos. HCLA, in partnership with Executive Core, has been …


MHA Joins Coalition Letter Opposing Federal Redefinition of Professional Degrees

The MHA joined a statewide coalition in signing a letter to Michigan’s congressional delegation expressing concern about a proposed federal change that would remove several health professions, including nursing and behavioral health fields, from the …


Webinar to Highlight Effective Cyber Incident Response

MHA Endorsed Business Partner CyberForce|Q is hosting the webinar Proactive Cyber Risk Measures from 11 a.m. to noon ET on Jan. 29. The session will feature speakers from Trinity Health, the Michigan State Cyber …


MHA Rounds image of Brian PetersMHA CEO Report — 2026, A Pivotal Year for Healthcare

As we look toward the year ahead, one thing is clear: healthcare will remain at the forefront of public debate. We’ve seen time and again how healthcare delivery is shaped by policy decisions. …


Keckley Report

Healthcare 2026: Three Realities

“Congress returns to DC this week to debate the merits of extending the advanced premium tax credits that enable coverage for 4 million in a climate of high anxiety about U.S. intervention in Venezuela and heightened tension with Russia and China.

Each sector in healthcare—hospitals, physician services, long-term care, insurers, life science manufacturers, enablers and advisors—is vulnerable. None welcomes unflattering attention and all spend heavily on messaging and advocacy to protect themselves.  All recognize the elephant in the room—large employers that have patiently funded the system’s profitability and value protective regulation that limit disruption. And in all, implementation of AI solutions that lower operating costs and streamline performance is THE immediate priority.

The realities of 2026 for healthcare are foreboding: business as usual is not an option.”

Paul Keckley, Jan. 4, 2026


MHA in the News

The MHA received media coverage during the week of Jan. 5, covering the increasing rate of flu-related hospitalizations in Michigan. Both Bridge and Michigan Public published stories during the week based on interviews with Jim …

MHA CEO Report — Dedicated to Care Every Day of the Year

MHA Rounds image of Brian Peters

MHA Rounds image of Brian Peters“Love and compassion are necessities, not luxuries. Without them, humanity cannot survive.” — Dalai Lama

During the holiday season, we look forward to annual traditions and time spent with loved ones. While many of us gather around our tables this season, we are all aware of individuals who sacrifice this special time with cherished company to keep the places of healing in our communities open.

Hospitals don’t close for the holidays. They are open 24 hours a day, 7 days a week, 365 days a year. Emergencies don’t check the calendar, and neither do the people who dedicate their lives to responding to them.

Every hospital in Michigan can provide round-the-clock service because of the remarkable network of professionals working there. There are teams of highly skilled clinicians ready at the bedside, but there is also a deep bench of essential staff working diligently behind the scenes. Nurses, physicians, medical assistants and countless other care providers are able to deliver comfort and support when it matters most thanks to the help of many colleagues whose work often goes unseen.

There are environmental services teams who ensure every room is safe and clean, maintenance workers who manage essential systems for heat, power and water, food service workers making meals for staff and patients, and lab technicians providing fast, accurate, results. Our hospitals employ accountants, attorneys, communications and IT professionals, and so many more.

And these individuals aren’t strangers. They are our neighbors, our friends and our family members. They are the people we see at the grocery store, at school events or in line for our morning coffee.

Their commitment means that when a baby spikes a fever or a parent slips on ice, help is always there. Their presence brings reassurance to every family in our community: no matter the hour or the day, hospitals stand ready.

To all those working this holiday season, thank you. You are there when we need you most, and our communities are stronger because of you.

As always, I welcome your thoughts.

MHA Monday Report Nov. 10, 2025

Congressman Bergman Co-Sponsors Critical Access Hospital Relief Act

U.S. Rep. Jack Bergman (R-MI) recently co-sponsored HR. 538, the Critical Access Hospital Relief Act of 2025, which would remove the 96-hour physician certification requirement for inpatient services at critical access hospitals. The bill, introduced in January 2025, would amend …


State and Medical Partners Urge Michiganders to Get the COVID-19 Vaccine

To help ensure access to the COVID-19 vaccine for all residents, the Michigan Department of Health and Human Services, Department of Licensing and Regulatory Affairs and Department of Insurance and Financial Services …


MMMS and FIMR Aligned Recommendations to Improve Maternal and Infant Health

The Michigan Maternal Mortality Surveillance (MMMS) and Fetal Infant Mortality Review (FIMR) programs recently released aligned recommendations at improving outcomes across the maternal and infant health continuum. MMMS reviews cases of maternal deaths that occur …


Honoring Veterans Through Improved Access & Care Coordination

When observing Veterans Day, it’s important to recognize how healthcare organizations can meaningfully work together to improve health outcomes and address the unique needs of service members and their families. …


Key Findings from the Michigan Interpreter Needs Assessment Report

Understanding the critical role interpreters play in hospitals, the MHA Health Foundation recently contributed funding to support the Michigan Department of Licensing and Regulatory Affairs in conducting a needs assessment of Michigan’s interpreter landscape. …


MHA Rounds graphic of Brian PetersMHA CEO Report — Streamlining Medicaid Work Requirements

As states work toward establishing Medicaid work requirements that are a core element of H.R. 1, it’s more important than ever that we reduce the administrative burden associated with verification for beneficiaries. …


Keckley Report

The Structural Flaws that Must be Fixed to Transform the U.S. Health System

“Such is the case for health insurance coverage for millions in the U.S. as the federal government shutdown enters Week 6. Democrats are holding out for continuation of Affordable Care Act (ACA) insurance subsidies that enable 22 million to “buy” insurance cheaper, and Republicans are holding out for federal spending cuts reflected in the One Big Beautiful Act (July 2025) that included almost a trillion reduction in Medicaid appropriations thru 2036.

ACA subsidies at the heart of the shutdown successfully expanded coverage in tandem with Medicaid expansion but added to its costs and set in motion corporatization and consolidation in every sector of the health system. The pandemic exposed the structural divide between public health programs and local health systems, and insurance premium increases and prior authorization protocols precipitated hostility toward insurers and blame games between hospitals, insurers and drug companies for perpetual cost increases. …

Sixteen years later, healthcare is once again the eye of the economic storm. Insiders blame inconsistent regulatory enforcement and lack of adequate funding as root causes. Outsiders blame lack of cost controls. consolidation and disregard for affordability. Thus, while attention to subsidized insurance coverage and SNAP benefits might temporarily calm public waters, they’re not the solution. …

Healthcare’s the same. Outside forces seen or not will impact its future dramatically. Plans have to be made though Black Swans like the pandemic are inevitable.  But long-term planning built on plausible bets are necessary to every healthcare organization’s future.”

Paul Keckley, Nov. 2, 2025


New to KnowNews to Know

  • MHA offices will be closed and no formal meetings will be scheduled Nov. 11 in honor of Veterans Day.
  • The MHA will host a virtual member forum from 8:30 to 9:30 a.m. Nov. 7 to outline the MHA 2025-26 Strategic Action Plan approved by the MHA Board of Trustees.
  • Amy Brown, chief nursing officer, MHA, recently joined MHA Endorsed Business Partner (EBP) AMN Healthcare on the episode “Empowering Nurses Through Advocacy and Innovation” of the Elevate Care Podcast.
  • MHA EBP SunRx is continuing a webinar series about 340B Rebate Model Briefings on Nov. 13 and Nov. 20.

MHA in the News

Bridge published a story Nov. 5 sharing five reasons why health insurance rates are rising at increasing rates in the state, which included workforce challenges, expiring enhanced premium tax credits, inflation and drug prices. …

MHA CEO Report — Streamlining Medicaid Work Requirements

MHA Rounds image of Brian Peters

“Alone we can do so little, together we can do so much.” — Helen Keller

MHA Rounds image of Brian PetersAs states work toward establishing Medicaid work requirements that are a core element of H.R. 1, it’s more important than ever that we reduce the administrative burden associated with verification for beneficiaries. Medicaid work requirements aim to advance accountability, but if not implemented correctly, they can increase costs for everyone and remove safety nets for those who need it most.

When reporting systems are confusing or overly complex, individuals that satisfy the requirements can still lose coverage simply because they can’t navigate the paperwork. When qualified individuals go without coverage, they tend to delay seeking care until a problem has worsened unnecessarily; at the same time, hospitals end up managing more uncompensated care. And when more people go uninsured, healthcare costs rise, affecting affordability for everyone.

The solution lies in intentional implementation. Michigan can successfully streamline the verification process by automating data sharing across agencies, offering multiple reporting options and communicating requirements clearly. In short, we need to follow the lead of some of the most successful and innovative companies in the private sector, such as Amazon and Uber, and make this process as user-friendly as possible.

By focusing on efficiency and simplicity, Michigan can protect taxpayer dollars, support employment and keep healthcare more affordable with an effective Medicaid work requirement program. The MHA is committed to working closely with all parties toward this goal.

As always, I welcome your thoughts.

MHA Monday Report Oct. 13, 2025

Healthcare Funding Protected in New State Budget Signed by Gov. Whitmer

The Michigan Legislature’s newly passed state budget, which protects all existing healthcare funding, was signed into law Oct. 7 by Gov. Whitmer. Public Act 22 of 2025, sponsored by Rep. Ann Bollin (R-Brighton), passed by both …


Community Benefit Collaborative Members Gather for Kickoff Event

The MHA brought together the Community Benefit Collaborative members for a daylong kickoff event on Oct. 2 to network and learn from peers across the state conducting community benefit work in chronic disease, behavioral health …


CDC Updates Guidance for COVID-19 and Chickenpox Vaccines

The Centers for Disease Control and Prevention (CDC) recently updated its guidance for the COVID-19 and varicella (chickenpox) vaccines. The CDC’s decision uses an individual-based decision-making framework, referring to vaccination decisions made through shared clinical …


Strengthening Rural Healthcare Through Smarter Physician Recruitment

MHA Endorsed Business Partner AMN Healthcare recently released the Rural Physician Recruiting Challenges and Solutions white paper, produced by its Physician Solutions division (formerly Merritt Hawkins). The resource identifies several approaches to address these challenges: Recruiting physicians …


Investing in Rural Hospitals Means Investing in Rural Michigan

When the One Big Beautiful Bill Act was signed into law in July, it created the Rural Health Transformation Program, a five-year, $50 billion investment in rural healthcare. The MHA Board of Trustees took swift action empowering an MHA board-appointed task force charged with creating …


Keckley Report

Shutdown Impact: The Affordable Care Act 2.0 Takes Center Stage

“In 2009, I facilitated discussions with key health industry trade associations and the White House Office of Health Reform focused on reforms to reduce costs, increase insurance coverage and improve quality by 2019. It was the Obama administration’s aim to use the health system’s bulk as a lever to stimulate recovery from the 2008-2009 recession and simultaneously increase coverage through Medicaid expansion and marketplace subsidies that for lower-income households. …

The current federal government shutdown is a tipping point for healthcare in the U.S. It’s about more than extended subsidies per Dem’s and holding the line on spending per Republicans. It’s about a growing sense of helplessness among the majority and resentment among many that institutions like the federal government, higher education, big business and healthcare are no longer motivated to serve interests beyond themselves. …

Some will harken back to the Affordable Care Act in 2010 when coverage was also the issue. We’re there again. But the bigger issue is this: extending subsidies and maintaining coverage will not lower spending or transform U.S. healthcare to an affordable, accessible, appropriately structured system of health.

The moral high ground for healthcare is in jeopardy and its direction unclear. Perhaps PPACA 2.0 is an answer. Doing nothing isn’t.”

Paul Keckley, Oct. 5, 2025

MHA Monday Report Oct. 6, 2025

Michigan Legislature Passes State Budget, Preserves Healthcare Funding

The Michigan House of Representatives and Michigan Senate passed a state budget protecting all existing healthcare funding on Oct. 3. House Bill 4706, sponsored by Rep. Ann Bollin (R-Brighton), passed by both chambers, includes …


CMS Shares Updates for Medicare Operations During Federal Shutdown

The Centers for Medicare and Medicaid Services (CMS) recently directed Medicare Administrative Contractors to hold Medicare fee-for-service claims for ten business days due to the expiration of several Medicare payment provisions and the Oct. …


Hospital Communicators Gather at MHA Communications Retreat

The 2025 MHA Communications Retreat brought together about 100 communications, marketing and public relations professionals from MHA-member facilities Oct. 1 to network and learn from peers across the state. The agenda featured sessions on reputation management …


CE Credits Available for Maternal Health Quality Improvement Modules

Continuing education (CE) credits are now available for obstetric teams that complete the Michigan Alliance for Innovation on Maternal Health (MI AIM) virtual modules. The approximately three-hour series consists of the following modules: MI AIM …


MDHHS Introduces New Provider Updates Under Michigan’s Mental Health Framework

The Michigan Department of Health and Human Services (MDHHS) recently introduced new requirements under the state’s Mental Health Framework to strengthen assessments, referrals and care coordination for Medicaid enrollees. These changes take effect beginning October …


MHA Rounds image of Brian PetersMHA CEO Report — Launching Collaboratives to Improve Community Health

In the healthcare community, we know that a person’s health is shaped outside the four walls of a hospital and our support must expand beyond acute care. The MHA recently launched community benefit collaboratives with …


Keckley Report

Who Owns the Public’s Health?

“September 2025 marks a significant shift in U.S. health policy, especially its approach to the public’s health. …

Public health is a vital part of the U.S. health system but a stepchild to its major players. In reality, the U.S. operates a dual system: one that serves those with insurance (public and private) and another for those without. Public health programs like SNAP, HeadStart, Federally Qualified Health Centers et. al., serve lower income and under-insured populations and integrate with local delivery systems emergency services and during mass-events like pandemics, mass-casualties and disease outbreaks. Funding for public health programs is 2-5% of total health spending shared between local, state and federal governments.

Studies show food, housing and income insecurity—areas targeted by public health– correlate to chronic disease prevalence and health costs. Unlike most developed systems of the world which operate at a lower cost and produce better population-health outcomes, our system perpetuates a structural divide between healthcare and public health. Integrating the two is a necessary strategy for system transformation, but a difficult task given entrenched animosity toward “the system” held by public health leaders and funding pressures.  The bridge between public health and the healthcare delivery systems is a two-lane road with lots of potholes at the federal level, and sometimes better in local communities. But funding seems to be an afterthought unless local communities deem it vital.”

Paul Keckley, Sept. 28, 2025


New to Know

News to Know

  • MHA Endorsed Business Partner (EBP) SunRx is hosting a 340B Regulatory Brief webinar Nov. 4 at 2 p.m. EDT with Bharath Krishnamurthy, health policy & analytics, American Hospital Association.
  • The American Hospital Association (AHA) is accepting applications for the AHA’s 2026 Dick Davidson NOVA Award.

 

MHA CEO Report — Patients Over Politics

MHA Rounds image of Brian Peters

MHA Rounds graphic of Brian Peters“Happy are those who dare courageously to defend what they love.”  — Ovid

Most people will find themselves in a hospital at one point or another, whether it’s to hold a loved one’s hand, welcome a child or receive needed – perhaps even life-saving – care.

I’m no exception. Like many others have done before and since, my wife and I looked to the team at Corewell Health Devos Children’s Hospital to keep our daughter safe and healthy while she was fighting for her life in their neonatal intensive care unit some 19 years ago (a story I recently shared on the MiCare Champion Cast). Needless to say, it’s in those moments that we realize just how personal – and non-partisan – healthcare truly is.

As an association, it’s our job to protect Michigan hospitals and safeguard healthcare services for patients and communities. That’s why in recent months we’ve spoken out against attacks to Medicaid – and why now – we’re ringing the alarm on the devastating impact proposed House budget cuts would have if signed into law.

Political posturing aside, here are the facts: Michigan hospitals stand to lose more than $2.5 billion under House Bill 4706, which would directly impact patient access to care in hospital beds, labor and delivery units, emergency departments, cancer treatment and many other vital service lines across the state. As we stated repeatedly during the debate on “One Big Beautiful Bill Act (OBBBA),” when service lines and hospitals close, access is not only lost for Medicaid recipients – it is lost for everyone.  In addition, this funding keeps our incredibly dedicated healthcare workers employed. The House-proposed budget puts more than 20,000 Michigan hospital jobs at risk and could result in a $4.9 billion loss to the state’s economy.

While some politicians point fingers, Michigan hospitals are focused on patients. It’s time to put egos aside and act as a united front when it comes to protecting access to care, helping our communities thrive and showing up for those who care for us all in times of joy, uncertainty and crisis.

We cannot let partisanship put lives at risk. On behalf of our MHA family, I ask you to show courage in speaking truth to power. I ask you to join me in urging lawmakers on both sides of the aisle to protect essential hospital funding by visiting our MHA Legislative Action Center.

As always, I welcome your thoughts.

MHA CEO Report — Hospitals Are Focused on Saving Both Lives and Costs

MHA Rounds graphic of Brian Peters

MHA Rounds graphic of Brian Peters“Persistence and resilience only come from having been given the chance to work through difficult problems.” — Gever Tulley

Hospitals exist to save lives and improve health. Every day, across every ZIP code in Michigan, our community hospitals are the place where babies are born, cancer is fought, lives are saved and families turn in their most vulnerable moments for hope, help and healing.

Nearly every Michigander has a story about a provider, nurse or physician whose care brought them peace and support during one of their most difficult moments. Which is why it’s so disheartening to see recent headlines that cast hospitals as profiteers rather than what they truly are — the lifeblood of our communities, doing everything possible to ensure access to high-quality, compassionate care.

Healthcare providers use every option to make sure patients receive the care they need in the right setting, regardless of their ability to pay. While public dialogue about healthcare affordability is vital, we cannot disregard the complexity of drug pricing, payment models and hospital care itself in these conversations.

One of the most common misconceptions about healthcare costs is that hospitals are profiting by inflating prescription drug prices, but hospitals do not manufacture drugs nor set their list prices. They purchase and administer these drugs, often under the most difficult circumstances in intensive care units, cancer infusion centers or operating rooms. A vial of medicine isn’t just handed over: it’s carefully stored, handled, prepared and delivered by an entire team of trained professionals with the expertise to ensure the right drug gets to the right patient at the right time.

That process involves significant investment in safety, staffing, technology and compliance — not to mention the rising labor and supply costs all hospitals across the nation are facing. In fact, labor costs are up 45% since 2014, compared to a 28% increase in inflation. These expenses are especially heavy for hospitals in rural or underserved areas, where resources are stretched thin but commitment to care cannot and will not waver.

It’s also important to note what hospitals charge is completely different from what a hospital is paid, and it’s certainly not what most patients pay. Nearly all Michiganders have health insurance, and insurance plans negotiate rates with hospitals that are often far lower than the list price. In fact, hospitals are price takers, typically collecting only a fraction of the charges listed on publicly posted pricing files: files that are shared in the name of transparency, even if those figures are easily manipulated to be taken out of context.

Moreover, hospital care isn’t one-size-fits-all. Treatment decisions are based on a patient’s specific condition, care setting and coverage. Drug prices can vary based on location, the severity of a patient’s condition, who is covering the cost of care—whether it’s private insurance, Medicare, Medicaid or the patient themselves—as well as dosage and method of administration. A medication delivered through an outpatient clinic may have vastly different requirements (and prices) than one used during an inpatient stay after surgery or trauma. Comparing these prices without explaining that nuance, as well as the frequency of use causes confusion, not clarity.

Despite these challenges, hospitals are actively working to make care more affordable. Michigan hospitals have embraced the use of biosimilars and generics, participate in discount programs and offer financial assistance for uninsured patients. Hospitals actively invest in community health, run outreach clinics and help patients access the medications and services they need to thrive. This is all despite the fact that Michigan is one of only four states in the country where hospitals had, on average, a negative margin, according to the Kaiser Family Foundation.

Every hospital in Michigan is part of a larger effort to strengthen our healthcare system — not just for today’s patients, but for future generations. We are employers, safety nets, disaster responders and anchors of trust. If hospitals close due to financial challenges, where will patients in those communities turn when they need lifesaving care?

Of course, affordability matters. But solutions should be rooted in partnership. We welcome conversations about how to increase transparency, reduce costs and improve care.

Michigan hospitals are essential to the solution and will be the first at the table to offer collaboration, just as we are the first place Michiganders go when they need life-saving care.

As always, I welcome your thoughts.