Crisis or Opportunity

The next 16 months will see a number of far-reaching decisions made those of is in the health insurance industry, health care providers and policymakers.

I’m advocating that our industry take advantage of what some might see as a series of crises and take the lead to shape the decisions that will be made.

I believe we can work together to create a better and more effective future in the delivery of health services. Without any doubt, we need to positively resolve the following challenges:

• Sustain the Healthy Michigan Program—but in a way to meet the future state match obligations through continued and enhanced savings.
• Accept that creative financing in Michigan’s Medicaid program cannot continue, and the future dependence on the HICA and Use tax revenue will likely end—but find a way to offset that loss of revenue with program integration, improved efficiencies and effective incentives as the rightful alternative.
• Demonstrate our commitment in advocating for competition in health insurance that can open new markets and opportunities while keeping our eye on the need for affordability.
• Promote to policy makers an evidenced-based focus on social determinants of health that provide us with a means for addressing the “root cause” of many of our health care issues affecting physical and behavioral utilization and related expense.

We know that the cost to operate the state’s health insurance plans for low income families, Medicaid and the Healthy Michigan Plan, will continue to increase, and without change would cost the state General Fund an additional $1 billion cumulatively over the next few years.

Why:

Lost revenues, including the expected end of the state’s Health Insurance Claims Act tax and the Use Tax paid by many providers.

New expenses, including the state’s Healthy Michigan match obligations and increased taxes under the Affordable Care Act that insurers must pay, and be reimbursed by state to retain actuarial soundness – along with the increased use of costly specialty pharmacy products.

If we are smart, we can overcome these challenges and emerge fiscally sound and with better health care for our citizens. Over the next few weeks, I’ll talk about a few of these ideas.