Michigan’s top health care priority:Insuring the uninsured Rick MurdockMichigan Association of Health Plans

1

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

2

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

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

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

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?

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

7

Far more uninsured than in individual market

8

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)

9

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.

10

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

11

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

12

MAHP and consumer groups agree

Subsidize by combination of government & private sector

Reinsurance options/pools

13

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

14

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)

15

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

16

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

17

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

18

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

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

20

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

21