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


Sandbox Party: An election year for kids

August 24, 2010
Photo of Jane Zehnder-Merrell

Jane Zehnder-Merrell

Thursday, the Sandbox Party will hold its conference to mobilize a broad range of stakeholders to support a coherent system of early care and education in Michigan.  The League is proud to be a supporter of this important event, designed to draw candidates’ attention to the needs of children.

An early care and education system would assure that children are born healthy; that they thrive and develop on track without suffering from untreated health conditions or avoidable developmental delay;  that they enter the K-12 system ready to succeed; and that they can read proficiently by the end of the third grade.

This goal is also the very first  strategy recommended  in the Early Warning report (pdf) recently issued by the Casey Foundation. It presented four recommendations  to increase the share of fourth graders proficient in reading.

In Michigan (pdf) only three of every 10 fourth-graders could read proficiently by the fourth grade, according to the 2009 National Assessment of Educational Progress. Children who can read proficiently by fourth grade are prepared to learn by reading as they advance academically.  Those without at least a modest skill level will be at high risk of being retained in grade and dropping out of school.

In reality all of us are stakeholders in this Sandbox effort as the state struggles to move forward economically and to increase the educational attainment of more residents so they can compete in the global economy.  By 2018 estimates suggest that two of every three jobs in Michigan will require training or education beyond high school.   

Right now we’re still trying to make sure more youth complete their high school education, particularly low-income and minority youth.  The first step to reaching that goal will require making sure that more children have what they need in early childhood to prepare them to be lifelong learners. 

— Jane Zehnder-Merrell


Helping kids feel good about themselves

August 20, 2010
Photo of Judy Putnam

Judy Putnam

With the start of school just a few weeks away, many families are planning shopping trips to get the right outfits for that important first day of school.

Thanks to a state program, some 157,000 children in Michigan’s poorest families will be able to join the annual back-to-school shopping ritual.

Department of Human Services Director Ismael Ahmed announced Thursday that children in families receiving cash assistance (FIP grants) will receive $79 per child the first week of September for the children’s clothing allowance.

“It’s designed to help children feel good about themselves in going back to school,’’ Ahmed said at a press conference.

That is a little less than last year ($84 per child) but it will go a long way in buying shoes, underwear, and new or used clothes for the new school year.

The League has advocated for the clothing allowance for many years. We agree that all kids deserve a good start at the beginning of the school year. Many of us can recall the excitement that accompanied the new outfit, new shoes and a spanking new pack of Crayolas.  

It’s important that all children get to partake in that excitement, but it’s especially true for disadvantaged kids, who are at high risk of falling behind and dropping out.

As the Legislature and governor try to finalize the budget for the year starting Oct. 1, such items as the clothing allowance are in ongoing jeopardy. The governor called for unspecified cuts of $50 million in next year’s Department of Human Services budget to try and balance the budget. That came after the Legislature resisted her ideas for new revenue, including a reasonable plan to reduce the sales tax but expand it to services.

The state budget is a complicated document that’s developed in a complicated process but sometimes our choices become clear and simple, such as making sure that all kids have a good start and decent clothes as the new school year commences.

— Judy Putnam


Surprise! Voters supported taxes

August 16, 2010

Sharon Parks

The August 3 primary election said a great deal about what voters care about, in addition to their preferred candidates for office. The election results sent a clear message that voters value public services, and they are willing to pay for those services.

While this shouldn’t come as a surprise to some of us optimists, an analysis by The Center for Michigan shows that voters overwhelmingly stepped up to the plate to pay for good roads, fire and police protection, services for seniors and libraries. 

According to one analyst, “People are finally starting to really feel the effect of government cutbacks.”

The Center for Michigan’s analysis showed the following: 

  • Voters approved 86 percent of the 623 ballot proposals affecting how much they would pay in taxes or fees.
  • Voters approved 96 percent of the requests to either renew taxes or restore rates that had previously been reduced.
  • Voters supported 69 percent of the proposals that were flat-out tax increases. 

These election results counter the noise from the Tea Party folks that the electorate is fed up, doesn’t value government, and is not willing to pay a dime more for government services. 

Our citizens aren’t stupid. They know what they need; they know what they value.  By in large, they want essential services continued in their communities even though the state will no longer pick up the tab.

There are other services, equally important, which have been cut and are likely to be cut further. The General Fund budget, with a deficit of at least a half-billion dollars or more, depending on whose numbers are used, is not yet resolved. Many more services are likely to be cut if the Legislature can’t agree on revenue solutions.

At that point, voters will be looking at cuts in higher education as they attempt to send kids to college, and cuts in Medicaid as they attempt to deal with their own medical issues or those of parents or grandparents.

There’s more — the state licenses and inspects day care facilities where our children and grandchildren spend time each week; they also license and inspect nursing homes where many of our family members reside. Those of us who eat out occasionally or often should take comfort in the fact that restaurants are also inspected. The parks and forests that we all enjoy are maintained at government expense — taxpayer dollars. 

Considering The Center for Michigan’s analysis, candidates should welcome the opportunity to talk taxes with voters. Let the voters know what’s at stake and ask whether they want to go without the services they are used to having. The answers may surprise more than a few hopeful candidates for state office. 

— Sharon Parks


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


Income tax drop is elephant in the room

August 11, 2010

Joanne Bump

An elephant sits in the room but few are talking about it. As Michigan’s legislative leaders grapple with the upcoming year’s budget gap, a scheduled income tax rate reduction is going to further increase budget pressures.  

As noted in the League’s new fact sheet Waiting for the Other Shoe to Drop?, the decrease in the income tax rate will result in over $1 billion of lost revenue over three years, starting in fiscal year 2012.  

 In 2007, the Legislature increased the state income tax rate to address a budget gap. At the time, lawmakers wanted to ensure that the law was temporary so they included a reversal in the tax rate from 4.35 percent back to 3.9 percent. The income tax rate will be reduced by 0.1 percent each October 1, beginning in 2011, until the rate returns to 3.9 percent.

The Michigan revenue picture is even worse now than when the rate increase was passed. Undoubtedly no one could have guessed in 2007 how bad things would get here in Michigan. As unemployment soared and personal income plummeted, state revenues have fallen dramatically.

In January, Michigan state government will experience a significant change in leadership, with a new governor and many new legislators. They will quickly learn that laws passed by a previous Legislature are going to lower future revenue streams and create additional budget gaps.

The League’s fact sheet points out that in the past when the income tax rate has been increased during difficult economic times, it has not been reduced until the unemployment rate has fallen and the economy is stronger.

It’s hard to imagine that by October 2011 the state economy will be recovered enough that we should be cutting revenues that are needed to support basic needs for people in our state.

— Joanne Bump


High cost of higher ed cuts

August 9, 2010

Jacqui Broughton

Going to college is expensive. It’s also one of the keys to getting out of or staying out of poverty, reducing your chances of unemployment, and attaining higher income.

Unfortunately, with tuition at both two-year and four-year institutions rising faster than the rate of inflation and median household income falling, many students are finding it harder and harder to go to college. (See our new report Pulling the Plug on Michigan’s Future: Why Draining Resources Hurts Tomorrow’s Workforce.)

What’s to blame for the increase in tuition? There are several factors, such as expenses relating to health care, fuel costs and some courses being more expensive to teach than others. However, a lot of it has to do with the state, over a period of years, cutting aid to higher ed. 

Over the last eight years (2002-2010) the state’s general fund has shrunk by 12.6 percent, but state funding to community colleges, public-four year schools, and state-funded financial aid programs has dropped by 15 percent. This lack of state support, coupled with the factors listed above has caused tuition at Michigan’s four-year public institutions to skyrocket. Over the same eight-year period, tuition and fees increased 88 percent at Michigan’s four-year public colleges and 40 percent at two-year institutions.

Overall, Michigan’s investment in higher ed ranked fifth from the bottom in the nation between 2005 and 2009 and our tuition increases rank seventh-highest over the same time period.

Because of these cuts in state support, causing tuition to soar, tuition is representing an ever-increasing share of household income for families at all levels. This especially hurts families at or below the poverty level (which is $17,285 for a family of three) who have the most to gain by going to college.

However, even as tuition rises and aid programs (including many need-based aid programs offered by the state) have been cut or drastically reduced, enrollment has not dropped as more families and individuals understand the need for education beyond high school.

This is causing more students to finance their college education through student loans. In 2008, over half of all four-year graduates had student loan debt, which averaged just over $22,000, and half of all full-time freshmen took out student loans, up from just 40 percent in 2001. 

Michigan cannot afford to have its young people graduating with tens of thousands of dollars in educational  debt due to our cutting aid to the institutions that will ensure Michigan stays competitive in a changing economy.  At a time where jobs are shifting from skills-based to knowledge-based, is it worth cutting off aid to the institutions that invest in our future?

— Jacqui Broughton