The Michigan Legislature reviewed, discussed and moved forward legislation the week of March 4 that positively impacts patients, hospitals and health systems. Notably, the legislature took final action a bill related to the Renaissance Zone Act, while committees reported out bills related to scope of practice and organ donation.
House Bill (HB) 5096, sponsored by Rep. Kristian Grant (D-Grand Rapids), makes important changes to the state’s Renaissance Zone Act. These changes allow for more local governments to take advantage of the benefits of a renaissance zone designation and increase flexibility around those designations. Renaissance zones support economic development opportunities and allow for important economic drivers, like hospitals, to thrive in a variety of circumstances. Without these alterations, hospitals who may benefit from their locality being designated as a renaissance zone would be unable to realize significant opportunity to maintain or increase access to care in vulnerable communities. The positive impact this could have on hospitals and health systems in Michigan is why the MHA supported this legislation. HB 5096 passed both chambers and it is on its way to Gov. Whitmer’s desk.
HB 5114, sponsored by Rep. Carrie Rheingans (D-Ann Arbor), aligns the Mental Health Code with the Public Health Code when defining scope for recognized clinical providers. Certified nurse practitioners, clinical nurse specialists-certified and physician assistants are not recognized currently in the Michigan Mental Health Code. This lack of inclusion results in care gaps and confusion regarding the scope of those professionals, depending on the patient they may be serving or the location within a hospital they may be working. The state continues to struggle with healthcare workforce shortages, particularly in the behavioral health space. Alignment throughout Michigan’s compiled laws allows for certified nurse practitioners, clinical nurse specialists-certified and physician assistants to provide care to the fullest extent possible. Without this definitional change, those providers will continue to be precluded from fully participating in the behavioral health care continuum. The House Health Policy Behavioral Health Subcommittee took testimony and recommended the full committee move forward with the change. The MHA supports this legislation and looks forward to further committee activity in the full House Health Policy Committee.
Lastly, the House Tax Policy Committee took testimony on and affirmatively voted out HB 4361 sponsored, by Rep. Felicia Brabec (D-Ann Arbor), which creates a tax credit for living organ donors. The adopted substitute language of the bill allows for an individual who donates an organ to claim a one-time $10,000 tax credit for the costs associated with being a living organ donor. Living organ donations increase the existing organ supply and create opportunities for individuals on the transplant list to receive an organ potentially sooner. Organs available for living donation include whole organs, like a kidney, pancreas intestine, and in rare cases, heart, as well as partial organs like a lung or liver lobe donation. Creating policies at the state level that support individuals choosing to be a living organ donor could result in increased donors and therefore more opportunities for individuals to receive an organ donation. HB 4361 will move on for consideration by the full House of Representatives and is supported by Gift of Life Michigan, Living Liver Foundation and the National Kidney Foundation.
“Mankind’s greatest achievements have come about by talking, and its greatest failures by not talking. It doesn’t have to be like this. Our greatest hopes could become reality in the future. With the technology at our disposal, the possibilities are unbounded. All we need to do is make sure we keep talking.” ―Stephen Hawking
The new year always brings two traditional speeches from lawmakers: Gov. Whitmer just recently delivered her annual State of the State address, while President Biden will share the annual State of the Union address on March 7. While the economy, housing, education, border security, climate change and other important issues are featured in these speeches, the reality is that healthcare remains a top concern for millions of Americans, and therefore will continue to be front and center for elected officials and candidates at the state and federal level throughout this election year.
The bottom line is that the fragility of the healthcare continuum was exposed during the pandemic and four years later, the aftershocks can still be felt. Let’s touch on just a few issues that dictate the state of healthcare in 2024:
Healthcare Workforce
Michigan hospitals employ roughly 219,000 people and are desperately trying to hire thousands more in every corner of the state. A survey we conducted last year showed there were over 27,000 job openings in Michigan hospitals. Hospitals are often the largest employer in their respective communities and serve as critical economic engines. It takes longer to deliver care when hospitals don’t have enough staff, impacting the experience of patients and families.
Much like other industries in Michigan, healthcare has a supply and demand issue, but we feel it in a uniquely acute manner: the aging population not only contributes to an exodus of talent from the field, but it increases demand for healthcare services at the same time. And because we are classic “price-takers” when it comes to a huge share of our business (i.e. Medicare and Medicaid tell us what they are going to pay), our ability to pass rising labor (and supply chain) costs along to consumers is extraordinarily limited. The financial performance of hospitals across the state and country has been negatively impacted as a direct result, and it fuels our advocacy efforts related to our ongoing viability.
Healthcare needs to continue to refill the talent pipeline and we’re making progress on these efforts. From the MI Hospital Careers campaign to the individual partnerships created between health system and secondary-education institutions, the effort is being made to increase the supply of future professionals. I’m encouraged to hear Gov. Whitmer’s proposal for tuition-free community college for all Michiganders who graduate from a Michigan high school. We have been active in advocating for such a policy to improve the number of students pursuing these pathways to address the nursing shortage.
Behavioral Health
Behavioral healthcare in Michigan continues to be in crisis. We need to fund, support and reform our systems to better meet the behavioral healthcare needs of our communities. Responding to MHA advocacy, the Michigan Legislature provided $50 million in grant funding last year to increase access to pediatric inpatient behavioral health services. We are encouraged by what our member hospitals have planned to improve access, but more needs to be done. This will be a focus area for us in Lansing through the rest of the year, specifically looking at solutions that include continuing to expand care locations, clarifying insurance coverage policies and increasing the number of providers.
Prescription Drug Affordability
Increasing prescription drug costs are a key driver of escalating healthcare costs. These increased costs are not just experienced by patients at their local pharmacies, but hospitals are also large purchasers of prescription drugs and are experiencing the same costs, threatening their viability. Data shows drug costs rose by 36.9% from 2019 to 2021 and currently account for the largest portion of healthcare insurance premiums, costing 22.2 cents for every dollar.
With these dramatic cost increases, the 340B drug pricing program has never been more important. This critical program allows safety net hospitals and other community care organizations to access certain outpatient prescription drugs at discounted prices. It does not require any state taxpayer dollars and has contributed to supporting access to care to Michigan’s most vulnerable patients for more than 30 years. We’re hopeful to see legislation passed to protect these hospitals and the benefits they provide, such as supporting OB services, financial assistance programs for low-income patients or lowering the cost of prescription drugs.
Emerging Technology and AI
Technology continues to provide many opportunities and growth for healthcare. It can serve as a “force-multiplier” that allows our staff to work smarter, extending their impact. If used correctly, technology can improve the patient experience, care delivery, worker satisfaction and more. We’re already seeing it with the dramatic growth in the utilization of telehealth and the emergence of artificial intelligence (AI) applications throughout healthcare. Technology can help expand access to care for many of our rural or disadvantaged residents who are confronted with a variety of social barriers.
We’re seeing great innovation when it comes to technology and I expect even more in the years ahead. The “disruptors,” that is to say, the large, global companies known for their technological innovation (and deep financial resources) are increasingly turning their attention toward the $4 trillion American healthcare market. These entities could be viewed as a potential threat to traditional healthcare providers, payors and others in the health ecosystem – but could also be viewed as potential collaborators and strategic partners. Without a doubt, the future delivery and financing model will be shaped in some way by this development.
At the same time, the rise of sophisticated technology and the inter-connectedness between healthcare entities, their patients and the rest of the world gives rise to the specter of cybercrime. This topic is worthy of its own special focus (stay tuned for more on that in the months ahead), but for now, let me just point to the fact that the MHA was proud to be ahead of the game in this regard, helping to launch our own healthcare-focused cybersecurity operations center right here in Michigan with MHA Endorsed Business Partner CyberForceQ.
These are just a few of the countless, complex issues that will impact Michigan healthcare in the year ahead. Plenty to be concerned about, for sure. But I remain fundamentally optimistic and hopeful about the future. Our healthcare workers are committed and resilient. And our policymakers continue to acknowledge the dependent relationship their communities have with healthcare. While I know better than to predict much of anything in an election year, I feel confident in predicting healthcare will continue to help make Michigan a better place, no matter what the political winds bring our way. All we need to do is continue our most human connection – let’s keep talking with each other and craft a positive future together.
“Let us not seek the Republican answer or the Democratic answer, but the right answer.” ― John F. Kennedy
Given that the Michigan Legislature has officially adjourned sine die, it is now an appropriate time to reflect on the success of our MHA advocacy throughout 2023. As always, healthcare was in the spotlight as a political and public policy priority. Our team was incredibly busy as we worked to support bills that would advance the health of individuals and communities, and to oppose those bills that would run counter to our mission.
A full recap of these pertinent bills is available, but I want to lift up a few of particular importance. First, for many years, the MHA has advocated for healthcare workers to have similar protections from violence as other first responders. We’re thankful House Bills 4520 and 4521 that increase the penalties for assaulting a healthcare worker or volunteer are soon to be signed by Gov. Whitmer. We know this legislation is just one step towards improving workplace safety and our association will continue to work on more opportunities to protect the healthcare workforce from violence through our advocacy at the state and federal level, the MHA Keystone Center and the MHA Service Corporation.
In addition, the governor signed legislation that will add protections found in the Affordable Care Act to Michigan law. Public Acts 156-163 of 2023 memorialize important protections for Michiganders, such as no-cost essential services, including preventive, mental health and emergency services. A variety of other bills await the return of the legislature in 2024 on issues including auto no-fault insurance, telemedicine, sharps containers, behavioral health policy, maternal and infant health and more.
Of course, seeing no action besides testimony on House Bills 4550-4552 is another testament to the work of our team. These bills would mandate one-size-fits-all nurse staffing ratios for all Michigan hospitals and create significant access issues for patients. As discussed at length in a recent CEO Report, the MHA has communicated with all 148 state legislators to explain the complexity associated with hospital staffing and the tangible solutions that will actually address workforce shortages. We have significantly increased the awareness and understanding of the issue for lawmakers, and the bills not receiving a vote in committee is an example of our effectiveness in that regard.
In addition to all these policy-oriented items, we successfully advocated to protect Medicaid funding for hospitals, including graduate medical education, rural access and OB stabilization, and also secured new funding for recruitment and retention of healthcare workers and for pediatric behavioral health. And of course, we stood tall to prevent any erosion in our Certificate of Need laws, or our medical liability reform protections, both of which continue to play an important role in ensuring access to quality, affordable care for all.
Our work also extends to Washington DC and Capitol Hill. We continue to work closely with the American Hospital Association on federal advocacy that supports Michigan hospitals on issues including Medicare policy, site-neutral payments, the 340B drug pricing program, the healthcare workforce and much more. And just as we have benefitted tremendously from our partnership with Public Affairs Associates (PAA) as our long-time advocacy firm here in Lansing, we are also pleased with our new partnership with Cornerstone Government Affairs, which is helping us with our important work at the federal level.
We cannot accomplish our advocacy goals without the individual commitment from our member hospitals and health systems, large and small. At the end of the day, our unity is our strength; a great example of this is the unified opposition letter – representing 100% of our membership – that we shared with lawmakers last month in opposition to the nurse staffing legislation.
There is a lot of uncertainty in the year ahead. As widely reported, the state House is evenly split between Republicans and Democrats until special elections are held next April. It is also no secret that 2024 is a presidential election year, with all the political dynamics and theatre that will inevitably accompany the entire process. Finally, depending on the outcome of the November election, the lame-duck session that will follow could either be a low-key affair with not much on the agenda…. or a nerve-wracking period fraught with unexpected twist and turns that could directly impact multiple priority issues. Regardless, I am extremely confident the MHA will continue to deliver outstanding results that support our healthcare workers, our patients and communities.
“Thought Of equality- as if it harm’d me, giving others the same chances and rights as myself- as if it were not indispensable to my own rights that others possess the same.” ― Walt Whitman, Leaves of Grass
As we have discussed in these monthly reports in the past, I am incredibly proud that the MHA is committed to the health equity journey, which once again has been identified by the MHA Board of Trustees as one of our association’s strategic pillars for this program year. We have made progress, with much more work on the docket.
It is clear that to achieve health equity, there are multiple complex factors that must be addressed, and by now most of us in the healthcare field recognize how issues like food insecurity, transportation and housing all play a significant role. But there is another important consideration: the ability to participate in elections is one of the foundational elements of our American democracy, and just as our member hospitals are very engaged in removing barriers to healthcare access, Secure Automatic Voter Registration (AVR) removes a barrier for low-income Michiganders in the voter registration process.
In our health equity journey, we have learned that we can’t take certain things for granted. A small but illustrative example: when my physician prescribes for me an important medication that must be refrigerated, neither one of us has traditionally thought twice about it….but what if the patient in question can’t afford their utilities bill, or can’t afford a refrigerator to begin with? In the same manner, most of us don’t think twice about registering to vote, either by driving to the Secretary of State office or logging on to our computer. But what if we don’t have a car and can’t afford a computer or internet access?
At the end of the day, the MHA is an advocacy organization, so we know all too well that elections at both the state and federal levels have major consequences on healthcare funding, and a wide range of public policies that affect health insurance, pharmaceutical access and so much more. It is only logical that the very people who are directly impacted by these healthcare funding and policy decisions should have a voice in the process.
House Bill 4983 currently introduced in the Michigan Legislature would help expand representation in Michigan by using existing government data to register eligible voters. Referred to as Secure Automatic Voter Registration, those receiving Medicaid benefits would be automatically registered to vote, increasing the number of eligible voters by approximately 400,000 to 600,000. Medicaid was picked for several specific reasons. First, the agency already verifies citizenship, which is a requirement for voter registration. Only limited non-health data would be securely and electronically shared with election officials, who would use this information to either register nonregistered Michiganders or update existing registration. New or updated voters would receive a mailer providing an opportunity to decline the registration or correct the information.
Second, registering Medicaid enrollees would address election inequities. People of color, new U.S. citizens, young adults, people with disabilities and low-income individuals are disproportionately excluded from voting in the U.S. and overrepresented among Medicaid enrollees. We know Medicaid beneficiaries, in aggregate, tend to have additional challenges that impede their ability to register to vote, such as working multiple jobs, transportation access, available childcare and other needs.
Lastly, Medicaid provides a secure avenue to update voter registration rolls, as Medicaid offices routinely work with public health information and have experience securely sharing data. The agency routinely shares data securely with other agencies to determine access to additional benefits and with outside organizations that provide healthcare and other services. Such a system streamlines the voter registration process because the state already has the required information on file needed to register to vote. It also allows information to be updated more regularly, improving the accuracy of the voter rolls.
The MHA supports efforts to increase voter participation and we believe that Medicaid Automatic Voter Registration helps to achieve that goal while improving the efficiency of voter registration. The country still only has 69.1% of the voting-age population registered to vote and we can do better. We also see communities with higher voter turnout have better health outcomes, in part due to increased attention and resources from elected officials. In our quest to address inequities across the board, Medicaid AVR is a step in the right direction of improving access to resources within Michigan’s minority and underrepresented populations.
Healthcare legislative activity in the Michigan Legislature included hearings on auto no-fault and several other bills during the week of Oct. 2. The Senate Finance, Insurance and Consumer Protection Committee held their first hearing on Senate Bills (SBs) 530 and 531. Introduced by Sen. Mary Cavanagh (D-Redford Twp.) and Sen. Sarah Anthony (D-Lansing), the legislation would adjust the hospital fee schedule, clarify the definition of Medicare and provide rate certainty for post-acute care providers. The MHA is supportive of this legislation and will be testifying in an upcoming committee hearing on the importance of hospital access for individuals involved in an auto accident.
The House Health Policy Committee voted out two MHA supported bills, House Bill (HB) 4101 and SB 384. Sponsored by Rep. Curt VanderWall (R-Ludington), HB 4101 would increase the time a speech language pathologist’s temporary license can be active while they complete required training. SB 384, sponsored by Sen. Kevin Hertel (D-St. Clair Shores), would prohibit insurers from discriminating against living organ donors. Further, the committee took testimony on two separate packages of bills. HBs 4131, 4213, 4579 and 4580 would increase telehealth access while HBs 4504, 4505, 4169 and 4170 would add Michigan to the interstate physical therapy and occupational therapy licensure compacts. The MHA is supportive of both the increases to telehealth access and licensure compact legislation.
The Senate Civil Rights, Judiciary, and Public Safety Committee took up SB 410, sponsored by Sen. Jeff Irwin (D-Ann Arbor), which would rescind prescription drug product immunity from liability, therefore allowing pharmaceutical drug product liability claims in the state. Current immunity has resulted in several complaints against manufacturers being dismissed. This legislation would allow complaints to move forward on their merits. The MHA is supportive of this legislation.
Lastly, the Senate Health Policy Committee took up SB 27, sponsored by Sen. Sarah Anthony (D-Lansing), which would ensure that behavioral health parity is meaningfully applied in Michigan. The MHA is supportive of this legislation as well as HB 4707, sponsored by Rep. Felicia Brabec (D-Ann Arbor). Both bills look to expand and protect access to behavioral health services through insurance coverage parity.
Members with questions about state legislative action may contact Adam Carlson at the MHA.
The MHA received media coverage the week of Sept. 25 regarding new auto no-fault legislation introduced in the Michigan Legislature and hospital staffing issues.
The MHA issued a media statement Sept. 26 from MHA CEO Brian Peters in support of Senate Bills 530 and 531, which would reform specific aspects of Michigan’s current auto no-fault insurance law.
Below is a collection of headlines from around the state.
The following statement can be attributed to Brian Peters, CEO of the Michigan Health & Hospital Association.
The fiscal year 2024 state budget approved by the Michigan Legislature renews a longstanding commitment lawmakers have made to the health and wellness of Michigan’s hospitals, health systems and communities.
We are extremely pleased to see the inclusion of new funding to support trauma centers and inpatient psychiatric services that will provide a net benefit of $92 million. Trauma centers at hospitals provide lifesaving treatment to people with the most severe injuries, ready at a moment’s notice for mass casualty events and catastrophic accidents with a vital network of EMS services. This added funding makes Michigan a national leader in recognizing the importance of access to trauma services and makes sure trauma centers can continue to be equipped with the resources needed to staff these services 24/7, year-round.
Michigan is also in the middle of a behavioral health crisis where the demand of patients needing inpatient care continues to increase. We commend the Legislature for recognizing this need and increasing rates to inpatient psychiatric facilities based on patient acuity to help hospitals afford the staffing, security and facilities necessary to accept patients with more severe illness.
In addition, the budget continues to support long-standing programs crucial to access to healthcare services throughout Michigan. These include funding for rural and critical access hospitals, obstetrical services, graduate medical education, the Healthy Michigan Plan and Michigan’s Medicaid population.
We look forward to a signed budget that provides hospitals with the needed support to continue to provide high-quality care to every patient.
Gov. Whitmer signed House Bill 4016 today, appropriating $75 million for the recruitment, retention and training of hospitals workers. This funding will directly benefit hospital workers and play an important role in helping to support hospitals experiencing a generational workforce shortage.
According to a recent survey of hospitals conducted by the MHA, there are more than 27,000 job openings in hospitals throughout Michigan, including nearly 8,500 nursing job opportunities. Other areas with a high need include technicians with more than 4,500 job openings, clinical assistants with 3,000 openings and 1,700 openings for operational support in areas such as environmental services and food service.
Hospital staffing levels determine patient capacity within facilities. Michigan has lost a high of about 1,700 staffed hospital beds since 2020 because of workforce shortages. Filling these job openings would increase statewide inpatient hospital capacity, expand service availability and assist in the transition of care outside of a hospital.
“Maintaining the sustainability of our healthcare workforce is a universal priority for all Michigan hospitals and health systems,” said MHA CEO Brian Peters. “We appreciate the work from the Michigan Legislature and Gov. Whitmer in passing this funding that will support hospital workers and help solve staffing shortages that persist throughout healthcare.”
House Bill 4016 was introduced by Rep. Angela Witwer (D-Delta Township) and passed the Michigan Senate Feb. 28 and the Michigan House of Representatives March 1 with bipartisan support.
Those interested in a healthcare career should visit the careers webpage of their local hospital or health system.
The Michigan Legislature passed a supplemental appropriation bill the week of Feb. 27 that included $75 million to help address the ongoing staffing crisis in hospitals. The appropriation was part of House Bill 4016. Hospitals were allocated the funds for recruitment, retention and training of healthcare workers.
After Gov. Whitmer signs HB 4016, the MHA will work closely with the administration to allocate the funds once they are made available by the state.
The MHA also published a media statement March 1 on the behalf of MHA CEO Brian Peters to thank the legislature for acting. “On behalf of our member hospitals and health systems, we are very thankful our partners in the Michigan Legislature recognized this need and continue to be involved in developing solutions to retain and expand healthcare talent in Michigan.” The statement was published in a Crain’s Detroit Business article.
Members with questions about workforce funding may contact Adam Carlson.
The following statement can be attributed to Brian Peters, CEO of the Michigan Health & Hospital Association.
Michiganders deserve local access to care from their hospitals, but that access has been threatened by a generational workforce shortage. On behalf of our member hospitals and health systems, we are very thankful our partners in the Michigan Legislature recognized this need and continue to be involved in developing solutions to retain and expand healthcare talent in Michigan. This supplemental appropriation will continue to assist in recruiting a talented and skilled workforce to Michigan hospitals, in addition to keeping and training existing staff.
There are currently more than 27,000 jobs available in Michigan hospitals. While our members continue to work closely with the education community to expand opportunities in the talent pipeline, this funding plays a crucial role in ensuring the viability of hospital service lines and capacity. We plan to work with the administration to ensure this funding is available as quickly as possible to make sure hospitals are staffed and ready for the health needs of all members of the community.
