Solutions
Possible Solutions: What Michigan and Other States Are Doing
The issue of the uninsured is now a topic of interest, importance and debate not only on the national level, but also in each unique Michigan community. The Michigan Health Insurance Access Advisory Council (MHIAC) supports 100 percent coverage for all Michigan residents, which requires shared financial responsibility by individuals, providers, insurers, employers, and government. This health coverage strategy should be continuous, affordable, and sustainable for individuals, families, and society. Coverage should encourage personal responsibility for maintaining positive health behaviors and promote appropriate utilization of services.
Basic benefit packages should promote access to high quality care that is effective, efficient, safe, timely, patient-centered and equitable. Benefit packages should allow patient options in decisions relating to treatment within the parameters of their coverage. Basic benefit packages should include preventive and screening services, outpatient prescriptive drugs, as well as outpatient and hospital services.
While MHIAC doesn’t specifically endorse the following projects and initiatives, their elements provide a wealth of information, perspective and potential for addressing the crisis of the uninsured in Michigan. For simplicity, the information on the states below is presented alphabetically. For more information on state health reforms, visit http://www.statecoverage.net/pdf/StateofStates2008.pdf or see the 2008 state coverage report by Academy Health on the MHIAC Web site.
Initiative |
Status (See Key Below) |
Key Features |
MICHIGAN INITIATIVES |
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Connecting Calhoun County 2008 |
Connecting Calhoun County is an unprecedented alliance of Calhoun County’s largest health care organizations together with statewide and regional partners working together to significantly expand health coverage for Calhoun County’s more than 20,000 uninsured citizens, starting immediately with expanded outreach efforts to provide coverage for children and working families in 2008. The program was launched in May 2008 and is being conducted by the Calhoun County Regional Health Alliance, The Michigan Health & Hospital Association, Calhoun County Health Plan, the Volunteer Center of Battle Creek and other health and human service providers. |
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Although this program does not have an implementation date, the goal of Michigan First is to provide access to affordable insurance coverage through a partnership with the health care industry and business community. Michigan First will develop guidelines for the benefits that will be offered. A number of private insurers will then customize the benefits within those parameters. The benefits will include preventive and primary care coverage, emergency room services, hospitalization, mental health and prescription drugs. Partial funding for the program will come from the federal government. The proposal also features the creation of a statewide information network for patients and promotes healthy lifestyles. |
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Health Access America - Saginaw County Campaign |
In 2007, Saginaw County was one of seven communities across the country, and the only community in Michigan, selected by the Washington, D.C.-based Healthcare Leadership Council (HLC) to launch a nonprofit pilot program aimed at helping the uninsured obtain health coverage. The Health Access America - Saginaw County campaign was an unprecedented alliance of the county's hospitals and health systems, key employer organizations, health departments, faith-based organizations, labor unions, human service organizations, local civic leaders and state and federal legislators. Through increased enrollment efforts, earned media strategies and creative tactics, the campaign enrolled nearly 2,700 formerly uninsured county residents in existing health care plans - almost tripling the HLC's campaign goal. The initiative went beyond traditional "Cover the Uninsured Week" activities by coordinating a low-cost, high impact series of events over six months that received tremendous visibility. Virtually all of the new enrollees - 99 percent - obtained health insurance coverage through existing public programs in Saginaw County, including State Children's Health Insurance Program (SCHIP) programs as well as Saginaw Health Plan products. |
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INITIATIVES IN OTHER STATES |
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The California proposal was based on prevention and health promotion, coverage for all Californians, and affordability and cost containment. The plan included subsidized coverage for eligible adults and children. Financing was to come from employers who did not provide healthcare coverage, tobacco taxes, hospitals, county governments and over $4 billion in Medicaid funds. |
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Enacted reforms that expanded the state’s high risk pool for children with pre-existing conditions aging out of All Kids. Established a medical home program for residents under 100 percent of the federal poverty level. The program also includes a premium assistance component for middle income families. |
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Dirigo Health was enacted in 2003. The program includes funding from employer contributions, state funds and federal Medicaid funds. The program offers two types of coverage: a Medicaid eligibility expansion program for parents of children under age 19 and DirigoChoice, a subsidized health insurance program. DirigoChoice is offered to small businesses, the self-employed and individuals lacking access to employer-sponsored insurance. Residents with incomes below 300 percent of the federal poverty level qualify for premium subsidies on a sliding scale. |
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Enacted reforms that provide subsidies to small employers and their employees. The program also included Medicaid expansions for childless adults and parents and caretakers relatives with a child living at home. The program will be financed through general funds, hospital uncompensated care savings, a one-time surplus from the state’s high risk pool and federal funds. |
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Enacted in 2006, the law mandates that all individuals who can afford insurance obtain it and employers must make a “fair share” contribution to employees’ health insurance coverage. The program also includes a Connector that is an independent state entity that helps small employers and individuals purchase affordable insurance. The program also includes insurance market reforms. |
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New Mexico residents would be required to purchase coverage. Subsidies would be available for low income residents. Employers would financially contribute towards the program. A central authority would be established to create accountability for data, analysis, plan management and policy. |
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The Pennsylvania proposal covers all children at or below 300 percent of the federal poverty level. There is a requirement for full-time college students to have health insurance. A new insurance product would be made available to small businesses and low-income workers. |
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Vermont enacted reform in 2006. Catamount Health Plan is a PPO offered by two insurers. Residents select their preferred plan but both offer comprehensive benefits. Residents may purchase the plans if they are uninsured, over age 18 and not eligible for employer-sponsored benefits. The program includes premium assistance and chronic care initiatives. |
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Enacted substantial reforms to provide access to coverage for all children in the state by 2010. The law authorizes funding for education, outreach and administrative simplification. The program also expands the State Children's Health Insurance Program (SCHIP) program to cover children in families with incomes up to 300 percent of the federal poverty level. The state will also develop a Connector similar to Massachusetts. Sliding scale premiums are available based on income. |
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Source: Academy Health, State of the States, January 2008: Rising to the Challenge.
Key To Understanding the Chart Above:
The initiative has been implemented or is in the process of being implemented |
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The initiative has been partially implemented or is being considered |
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The initiative has been delayed |
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Initiative was not approved by the State Senate |
