Big Band-Aid over budget hole

September 9, 2010

Sharon Parks

It appears that House and Senate leadership and the administration have hammered out a budget deal that will avert a third state shutdown in four years.

I suppose we should all be relieved but somehow the whole thing leaves some of us feeling pretty frustrated. The final budget resolution seems to be a very large Band-Aid over a gaping hole.

Included among the budget “fixes” are proposals for tax amnesty ($61.8 million), state employee retirements ($60 million), use taxes on Health Maintenance Organizations ($377.3 million), various liquor reforms ($9 million), and a shift of $208 million from the School Aid Fund to the General Fund to avoid further cuts to community colleges.

The budget deal also includes more cuts in state spending—3 percent to all departments and reductions of $50 million each in the departments of Human Services, Community Health and Corrections.

It’s too early to know how $150 million will be squeezed out of these departments, on top of reductions that have been made since 2004 and continued in each subsequent year’s budget. (Notable exceptions are the optional Medicaid services that were eliminated in the 2010 budget but restored in the 2011 budget deal.)

Thank goodness for the federal Recovery Act money that is spread throughout the budget, and for the recent extenstion of the enhanced Medicaid match.  Those dollars helped avoid deeper cuts than are being made—for now. 

Finally, there is wide acknowledgement that the root of our problem extends beyond the current economic firestorm. Yet, what’s missing in this budget deal is any serious attempt to address the state’s structural deficit. It’s a “get out of Dodge” budget that dumps the problem squarely in the laps of the next administration and Legislature. 

Maybe the newcomers will be the breath of fresh air that is needed.  Maybe they will be full of good ideas, resolve and the leadership that is needed to turn Michigan in the right direction. Or, they may come to Lansing and waste valuable time as they learn their assumptions were faulty and their stereotypes untrue. 

I hope it’s not the latter. This train is headed for the cliff, as billions of federal Recovery Act funds end and our own state revenues continue to drop in response to the decline in personal income in Michigan.

— Sharon Parks


1994 principles relevant today

August 30, 2010

Jan Hudson

Federal health care reform is starting a new chapter in Michigan. Beginning tomorrow, enrollment will open for the new high risk pool  for those with pre-existing conditions who have been uninsured six months. Coverage will be effective Oct.  1.

This component of the health care reform law got off to a rocky start when the Michigan Legislature failed to approve the expenditure of the federal funds for the high risk pool.  The federal government had to step in and make alternate arrangements. 

Health care reform implementation merits ongoing and careful thought and planning by policymakers, with input and monitoring by consumers, to ensure the best possible outcome for all of us.  

The Michigan League for Human Services developed a set of health reform principles in 1994 that are still relevant today and can serve as a good resource. 

They provide a good road map for navigating many upcoming implementation issues including:

  • The critical importance of a comprehensive package of benefits for those newly eligible for Medicaid (there is an option to provide a lesser package of benefits) as well as for those who purchase coverage through the Health Insurance Exchange (the “Expedia” of private insurance options).  A comprehensive package would include the full range of mental and physical health services, as well as dental and substance abuse services.
  • Adequate state regulatory and monitoring resources to ensure mandates are implemented timely and effectively, and that there are strong enforceable consumer protections.
  • Availability of access to quality care both geographically and culturally.  There are many opportunities in the law to expand or promote primary care.
  • Reasonable and adequate provider payment rates in public programs to ensure that current and newly eligible persons have access to care and not just a card.
  • An increase in the meaningful and cost-effective use of health information technology.
  • Promotion of quality, not quantity, of care through incentives or payments for outcomes, or other payment reforms for providers; and quality consumer education to help guide treatment decisions.
  • A priority for funding prevention and wellness options included, but not funded, in the law.
  • Development of effective cost containment strategies that maintain or improve quality care and are not simply code words for cuts in programs or services.

 Additional food for thought is provided by the State Consortium on Health Care Reform Implementation in a State Health Policy Briefing. This brief describes 10 aspects of federal health reform that states must get right if they are to be successful in implementation.

The group’s top priorities include:

1. Be strategic with insurance exchange

2. Regulate the commercial health insurance market effectively

3. Simplify and integrate eligibility systems

4. Expand provider and health system capacity

5. Attend to benefit design

6. Focus on the dually eligible

7. Use your data

8. Pursue population health goals

9. Engage the public in policy development and implementation

10. Demand quality and efficiency from the health care system.

(The State Consortium on Health Care Reform Implementation is a collaboration among the National Governors Association, the National Academy for State Health Policy, the National Association of Insurance Commissioners, and the National Association of State Medicaid Directors.)

There have been and will continue to be numerous opportunities for comment as federal regulations are developed and finalized.  The federal government has established a website where you can readily view the regulations for which comments are being accepted.  You are encouraged to take advantage of these opportunities and let your voice be heard in this historic process.

It will take ongoing vigilance to ensure the best implemenation for all.

 —  Jan Hudson


Chronic conditions: Attacking our wallets

August 12, 2010

Jan Hudson

The Center for Healthcare Research and Transformation (CHRT) recently released a brief on the high cost of treating chronic conditions in Michigan. 

Annual spending for someone with a chronic condition can range from $3,800 to $38,000 more than for someone without a chronic condition. 

The brief reports that nationally 5 percent of the people with the most complex conditions account for 49 percent of U.S. health care spending, while 20 percent of the population account for 80 percent of total health care spending. 

Heart disease was by far the most costly chronic condition both nationally and in Michigan. Total annual spending per patient by Blue Cross Blue Shield of Michigan in 2008 for heart disease ranged from $16,900 to $41,000.

These costs document the importance of good public policy and strategies to address chronic diseases – both their prevention and their effective management. Prevention programs have certainly not been a priority for Michigan policymakers in the last several years as funding for programs has been dramatically reduced and programs have been eliminated.

In FY2008, the Healthy Michigan Fund, a key funding source for prevention and health education programs, provided $26 million for programs.  By FY2010, the amount had been reduced to $11 million, and the FY2011 Senate-passed budget further reduces program funding to $5.9 million. 

Many of these programs are considered ‘nice, but not essential.’ Cardiovascular health programs have been cut by nearly 50 percent, diabetes programs have been cut by more than 60 percent, and smoking prevention programs have been cut by 30 percent. Michigan needs to reverse this trend in disinvestment. 

Fortunately, the Affordable Care Act provides many opportunities to develop new strategies and demonstration projects to determine what works best. Policymakers must be encouraged to fund these opportunities and to make these critical investments.

In addition, the Affordable Care Act requires new health plans, beginning on or after September 23, to provide recommended prevention services (e.g., screenings for high cholesterol, high blood pressure, or diabetes) without any cost sharing by the patient.  In January, Medicare beneficiaries will have access to these recommended prevention services without any cost sharing.

Policymakers often talk about the need for personal responsibility in health matters, but people need the tools to be successful.  We cannot wait any longer to address the impacts of chronic disease.  As the CHRT brief notes, “chronic conditions are attacking our wallets,” particularly the state and the business community that pay for much of Michigan residents’ health care.

— Jan Hudson


Michigan Is Ours!

July 19, 2010

Jan Hudson

The League of Women Voters of Michigan recently completed a project called Michigan Is Ours! that documents the loss of state dollars to fund public services over the last 10 years, in part due to tax policies that reduce taxes. The group is advocating for a reversal of this trend.

In its background information, the League of Women Voters cites the negative consequences  to state services  because of the dramatic decline in state revenues, including:

  • the reduction in state workforce– 18 percent, over the last seven years.
  • the dramatic decline in public safety funding– $3 billion, since September 11, 2001.
  • the astonishing decline in state investments in higher education.

The group’s members believe that the “T” word is not a terrible word, but is a necessary word if we are going to have quality public services.  They further believe voters are concerned about such services as education, public safety, social services, health care, employment services, safe food and water, parks, libraries, and roads, and are willing to pay for them. 

As part of this project, the League of Women Voters has created a series of postcards on specific public services to be sent to legislators. These postcards have a simple message: they affirm the voter’s support for a specific public service and further affirm the voter’s willingness to pay more taxes to support it.  They encourage legislators to pursue tax changes to increase state revenues to support these essential public services.

The Michigan League for Human Services also advocates for tax policy changes to increase state revenues to support key public services.  Numerous options are available to policymakers.  Please see our Facts Matter report for more information. 

If you think a change in direction is in order, and support public services, including adequate taxes to pay for them, let your legislators know.  You can contact Jackie Benson at the Michigan League for Human Services, Jbenson@michleagueforhumansvs.org, for a supply of postcards.

Thanks to the League of Women Voters for creating such an easy way for us to communicate our priorities and willingness to pay more taxes for public services to our legislators.

— Jan Hudson


How to achieve health equity

July 13, 2010

Karen Holcomb-Merrill

A Path Toward Health Equity, a recently released report from Community Catalyst, contains recommendations on how to strengthen community-based work to reduce health disparities.  The report focused on six states, one of which was Michigan. 

I had the opportunity to share my perspective on health equity work in Michigan, as the report was being developed.  Although it focuses primarily on specific recommendations about how to more effectively address health disparities, the report also contains some important information about the status of health disparities in our state.

The numbers serve as yet another reminder of the disparities that do exist.  Overall, 13 percent of those in Michigan are uninsured.  Among Hispanics, 24 percent are uninsured and among African Americans, 20 percent are without insurance.

Across the board, African Americans in Michigan die from preventable diseases at a much higher rate than whites.  African Americans and Hispanics have significantly higher infant mortality rates than whites in our state.  You can find more detail about these and other disparities in a League report on health disparities.

The Community Catalyst report proposes five strategies that could strengthen efforts at the local and state level to reduce health disparities.  They include:

  • Building and strengthening community-based organizations
  • Encouraging statewide health access groups to prioritize equity work
  • Building coalitions of community, state and national organizations
  • Connecting various stakeholders
  • Developing a disparities reduction/health equity policy agenda

We are already doing some of these things here in Michigan.  But the numbers tell us that we need to do better.  The League will continue to look for opportunities to play a role in reducing health disparities in our state.

— Karen Holcomb-Merrill


Getting health reform right the first time

June 29, 2010

Jan Hudson

Policymakers in Michigan will soon have key decisions to make as health reform implementation progresses. Will they choose to do it right the first time, or follow their current strategy of remedial public policy?

When programs require a financial investment, policymakers say the state has no money to invest, and yet there are always funds to cover remedial services. Will the current approach of cutting programs in the name of fiscal restraint only to fund those necessary services in higher-cost settings be their guide?

For example, children are eligible for Medicaid or MIChild, but are not aware or enrolled because outreach funds and efforts have been eliminated. They are then treated in hospital emergency rooms instead of doctors offices. Or, Medicaid services are eliminated “to save funds” and untreated illnesses become life-threatening, resulting in intensive care stays that could have been avoided.

Early childhood and education programs have been cut or weakened through continued state disinvestment. A Casey Foundation report ranks Michigan ranks 34th among the 50 states in children who are proficient at reading by the end of third grade. Colleges then spend considerable time and cost on remedial education to correct the deficiencies.

Community mental health services are inadequately funded and were severely cut in this budget year. This means services are not provided until a crisis occurs, resulting at times with a person entering the corrections system. Wayne County Prosecutor Kym Worthy recently called for more aggressive mental health, preschool and drug treatment funding.

Federal health care reform presents the opportunity to make dramatic changes in the health care system and the way it’s delivered, defined and funded. A key question is: Will policymakers take advantage of these opportunities — pass needed legislation, and provide the necessary funding and staff for a successful implementation, or will they try to “do more with less” and skate by on the cheap?

If policymakers choose the short-sighted approach in the name of fiscal restraint  then we cannot expect to see the full potential of improvements to the current systems and health outcomes. It is critical that they acknowledge the need for additional resources and supporting public policy so that health reform implementation can be done right the first time.

We can pay now, we can pay later – or both. Will health care reform be more of the same, or will it be implemented right the first time?

— Jan Hudson


Ouch! Survey results pinch

June 17, 2010

Judy Putnam

A recently released survey of local Michigan officials has a depressing finding: Only 1 percent of local officials think the American Recovery and Reinvestment Act has helped improve local economic conditions “very much.” Two out of every three say it has not helped at all to date, and more than half predict it won’t help at all over the long term.

Ouch! That’s a blow for those of us who have been advocating for extending vital features of the ARRA. (Those include extending the enhanced federal Medicaid match that will offer more than $500 million for next year’s state budget, Earned Income Tax Credit expansions, Child Tax Credit to benefit working poor families of nearly 600,000 kids in Michigan and 99 weeks of unemployment benefits for the state’s long-term unemployed.)

ARRA has poured critical dollars into our state at a critical time. Few of those dollars, however, went directly to local governments, a fact pointed out by the Michigan Municipal League in a well-publicized letter to Vice President Biden last year. Local governments struggle with the double whammy of sharply reduced revenue sharing from the state and declining property values, causing layoffs of public safety workers and other hardships.

But the Recovery Act money has flowed to many people in the communities: the unemployed, households on food assistance, those on Social Security and taxpayers. It is credited with saving an estimated 12,000 jobs in Michigan, most of them in education.  That help doesn’t go into a black hole — those are dollars that are quickly circulated in local economies.

The survey of more than 1,000 local officials was completed last fall. Perhaps, with time, more will see the benefit to their communities in projects such as weatherization.

Without doubt, the ARRA has paid off for local communities, even as tough times continue. What’s hard to imagine is how much worse it would be without the Recovery Act.

Michigan needed the Recovery Act in 2009. It needs it now – it’s important that Congress votes to extend the enhanced Medicaid match, EITC expansions, unemployment benefits and the Child Tax credit.

— Judy Putnam