Universal Means for Everyone!

1. Universal Means for Everyone! It’s the promise of this grant. Michicare? Better for people: better for business 120505 Universal- Multi Payer PowerPoint

2. Coverage • Everybody in! • Phase in uninsured first. • No means test • Insurance not related to employment • All are automatically in the plan • Present HMO’s; Blue Cross; HAP and selected others to bid on covering the uninsured and on everyone within 5 years. 120505 Universal- Multi Payer PowerPoint

3. Summary • Early phases focus on primary and preventive care. • Multiple payers but substantially fewer than at present. • State to collect funds and contract with health insurance carriers as we do in Medicaid. • Capitation rate to insurers in either case. 120505 Universal- Multi Payer PowerPoint

4. Funding Summary • Integrate workers’ disability [WC], motor vehicle medical coverage [PIP], and other medical coverage to lessen administrative and claims overhead. • Legislate that there can be no exclusions for WC, PIP or other categorical coverage – one policy/one person. • Assess a fee to motor vehicle owners, individuals, and employers at a rate lower than present WC, PIP, administrative costs and capture funds for coverage. 120505 Universal- Multi Payer PowerPoint

5. Timeline – Year One and Two • Year One – make changes to WC; PIP etc and begin collecting funds. • Give DCH authority over all medical programs and discretion over use of funds. • Use funds to cover the uninsured in year one or two, as funds needed are collected. • Begin debate over a fair financing system needed to make system permanent, universal, and comprehensive 120505 Universal- Multi Payer PowerPoint

6. Time Line – Year Two and Three Cover everyone! Assess and implement benefits based on finances Focus on chronic diseases State to establish price limits for procedures and care such as WC’s cost containment Age tiering – people on Medicare would need less coverage from Michicare. Establish savings based on quality measures and mechanism to collect portion of savings 120505 Universal- Multi Payer PowerPoint

7. Time Line – Year Four and Five • Assure comprehensive benefits as in Michicare legislation. • Implement general fair financing mechanism to take the burden of health insurance off of employers. • System unique to Michigan would draw business to the state. 120505 Universal- Multi Payer PowerPoint

8. Benefit Package • Phase One – Collecting funds and programs under DCH. • Phase Two – Covering the Uninsured – Medicaid benefit package. • Phase Three – Covering All – depending on funds – comprehensive benefit package. Take burden off of employers! 120505 Universal- Multi Payer PowerPoint

9. Quality of Care/Effect on Delivery System • Use incentives to promote evidence-based medicine • Use pay-for-performance model to save on quality • Use disease-based protocols • Use incentives to patients to promote healthy behavior • Use incentives to providers to promote the use of electronic records, or simply require this • Use incentive plans for geographic access 120505 Universal- Multi Payer PowerPoint

10. Quality Control • Establish mechanism to measure savings because of quality control • Establish savings goals (savings in Maine were $43 million in a system 1/10th the size of Michigan) 120505 Universal- Multi Payer PowerPoint

11. Cost Considerations • Anticipate greater cost when uninsured first get covered; with lessening thereafter. • Cost containment by negotiating of pharmaceutical prices; evidence based medicine; e-record keeping; disease based protocols • Decreasing number of insurers decreases overhead • Ending WC, PIP and other medical coverage lessens claims systems and disputes. 120505 Universal- Multi Payer PowerPoint

12. Capturing the Money - Example • PIP and Catastrophic Claims premiums to go to DCH. • As costs brought under control drop these rates. • Eventually end the premium system and create a fee per motor vehicle at a rate less than present day premiums to go to DCH to provide health insurance 120505 Universal- Multi Payer PowerPoint

13. Medicaid?? • Use funds to expand Medicaid program capturing federal match • Allows expansion of Medicaid through present HMO driven system 120505 Universal- Multi Payer PowerPoint

14. Fairness • Everyone is covered!!. • Problems of ‘over-insurance’ lessened. • Decreasing administrative cost for all. • Quick access for uninsured to primary/preventive care decreases use of ER in near future. • Care management and disease based treatment lessen costs. 120505 Universal- Multi Payer PowerPoint

15. Equity • All have set benefits for medically necessary services. • Allowed to buy policy covering more. • No coverage issues with claims of categorical coverage. • No loss of health insurance if job is lost. • Increased regulation, and increased incentives. 120505 Universal- Multi Payer PowerPoint

16. Consumer Choice • Consumer given list of insurance companies or HMO’s to choose from. • May choose any company. • Providers not limited. 120505 Universal- Multi Payer PowerPoint

17. End some programs to increase funds used for general health insurance. Greater regulation of provider pricing. Employers lose ‘control’ of HI industry. Medical malpractice premiums should drop. Universal system would draw business into the state. Tradeoffs 120505 Universal- Multi Payer PowerPoint

18. Tradeoffs Health insurance off the collective bargaining table Greater regulation of pharmaceutical pricing through negotiation Note: System would not affect technological innovation 120505 Universal- Multi Payer PowerPoint