michigan s top health care priority insuring the uninsured
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Michigan’s top health care priority: Insuring the uninsured . Rick Murdock Michigan Association of Health Plans. Michigan Association of Health Plans. Industry voice for 19 health care plans Members cover over 2.4 million Michigan residents Our mission: Advocate for health care that is

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michigan s top health care priority insuring the uninsured

Michigan’s top health care priority:Insuring the uninsured

Rick Murdock

Michigan Association of Health Plans

michigan association of health plans
Michigan Association of Health Plans
  • Industry voice for 19 health care plans
  • Members cover over 2.4 million Michigan residents
  • Our mission: Advocate for health care that is
    • High quality
    • Affordable
    • Accessible
mahp agenda for michigan
MAHP Agenda for Michigan
  • Don’t fix what’s not broken
  • Don’t fix what people don’t want fixed
  • Fix what people do want to fix
  • Fix what policymakers agree needs to be fixed
don t fix what s not broken
Don’t fix what’s not broken
  • How would you rank the quality of your health insurance today?
    • Excellent 35%
    • Good 37
    • Fair 15
    • Less than fair 4
    • Poor 3

Statewide MAHP commissioned phone survey, 600 likely voters, 9/13-17, 2009

72 percent of people consider their health insurance excellent or good

fix what people want fixed
Fix what people want fixed
  • Do you support or oppose making it a priority to give every single Michigan citizen quality and affordable healthcare?
    • Strongly support 47%
    • Somewhat support 24
    • Somewhat oppose 13
    • Strongly oppose 13

71 percent support giving all quality health care

fix what policymakers know needs to be fixed
Fix what policymakers know needs to be fixed
  • About 1.1 million uninsured
  • Drives up health care cost for all
  • Still get health care
    • Often at expensive emergency rooms
    • Uncompensated care = Cost shifting
    • Average family paying $1,000/year due to uncompensated care
  • Getting more people into managed care can mean lower costs for all
who benefits by covering uninsured
Who benefits by covering uninsured?
  • The uninsured
  • Businesses who are paying $1,000/covered family in hidden taxes for uncompensated care caused by state and federal policies
  • Hospitals and physicians who are covering the uninsured today
characteristics of smart expansion of insurance to uninsured
Characteristics of smart expansion of insurance to uninsured
  • Create a level playing field for all insurers
    • More competition is good for all consumers
  • Consumer-centric
  • Serving greater public good not one interest
  • Take pressure off of other insurers (cross-subsidy, uncompensated care)
characteristics of smart expansion of insurance to uninsured10
Characteristics of smart expansion of insurance to uninsured
  • All interest groups have a stake in its implementation (Pay/Play)
  • Advances competition on quality and performance
  • Must provide certainty of coverage, costs, and responsibility.
characteristics of smart expansion of insurance to uninsured11
Characteristics of smart expansion of insurance to uninsured
  • Maximize use of Medicaid/MiChild (Preserving safety net)
    • Established programs
    • History of working well
    • Need to ensure all people who are eligible are in these programs
    • Let’s federal government share costs
mahp and consumer groups agree
MAHP and consumer groups agree
  • Standard benefits package
  • All carriers required offer, limited by market share
  • Low income subsidized in some fashion
  • Consistent treatment of pre-existing conditions by all carriers
    • Goal is to limit gaming of system
    • But still ensure those in need can get care
mahp and consumer groups agree13
MAHP and consumer groups agree
  • Subsidize by combination of government & private sector
  • Reinsurance options/pools
policy changes needed
Policy changes needed
  • Boost Medicaid coverage by maximizing federal support
    • Need to increase state match substantially
    • Use existing $ now allocated toward uninsured
    • Establish consensus on other revenue sources including self insured and insured
      • Small investment to dramatically cut $1,000 “hidden tax” that all commercial subscribers paid today
for those not eligible for medicaid
For those not eligible for Medicaid
  • Require all carriers to offer the same basic benefit packages
    • Include doctor visits
    • Some level of hospitalization
    • Smart use of pharma
    • Smart use of copays
      • High copay for ER
      • No copay for maintenance drugs (Value based purchasing)
for those not eligible for medicaid16
For those not eligible for Medicaid
  • Subsidize so not pay more than 10 percent of income for coverage
  • Subsidy comes from same sources used for Medicaid full funding
for those not eligible for medicaid17
For those not eligible for Medicaid
  • Provide for key consumer protections
    • Guaranteed issue proportional to market share
    • 6 month limit on pre-existing conditions and other consumer protections agreed to in both House and Senate discussions
number of technical issues
Number of technical issues
  • Must have level playing field on provider payments
    • If companies can negotiate different rates, system falls apart
  • Need reinsurance plan—what level or attachment point
  • How much hospitalization?
  • Annual cap?

These can be worked out if broad plan adopted

this plan can work
This plan can work
  • Creates competition
    • Many companies offering similar product
  • Maximizes federal dollars
    • Feds willing to pay $1.71 for every $1 state pays
  • Provides consumer protections
  • Lessens problems of individual market
  • Cuts cost of uncompensated care
  • Cuts hidden tax now imposed on all insured
concepts being explored by legislature
Concepts being explored by Legislature
  • Sen. Tom George, Rep. Marc Corriveau issue their plans—both Chairs communicating issues with each other
  • Many pieces of MAHP/consumer proposal in both
  • Helping them to work out differences
  • Hope to see resolution this year
other reforms
Other reforms
  • Recognize some regulatory reform needed
    • Make it easier for carriers to bring products to market
    • Accelerated rate approval process for all carriers
      • This prevents rate shocks
      • Increases competition
    • Preserving appropriate regulatory oversight
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