The passage of the Federal Health Care Reform bill did not happen overnight. When the issue of health care reform surfaced in the 2008 presidential campaign as a focus issue for the country, the Michigan legislature had already considered legislation to improve the process for providing insurance coverage for the State's uninsured population. As the Federal bill was debated and continued to materialize, the Michigan legislature continued to debate on its own, a series of bills that would accelerate the time line of the final federal bill. A series of four bills (HB 6034-6037), the Individual Market Healthcare Reform Package, is a compromise package intended "to make quality health-care more accessible and accountable for all Michigan residents.". In particular, this series of bills guarantees health care to all Michigan residents as it requires all insurance carriers to provide two health plan options: standard and enhanced. The key feature of this bill, in alignment with the federal health care bill is the assurance that an individual cannot be rejected from the plan based on a pre-existing condition. In addition, the bill addresses affordability by creating the Michigan Catastrophic Protection Plan (MICAPP) Board to administer the Michigan Claims Fund and a Healthcare Affordability Fund. The chair of the State House Subcommittee on Health Care Policy, Representative Marc Corriveau (D) worked across the aisle with Senator Tom George, MD (R) to craft these bills in alignment with the Federal Health Care Reform package.
These bills reflect compromises made prior to the final passage of Federal Health Care Reform. For the state of Michigan, the data for the uninsured population is provided. Michigan is in the category with 13-17% of the non-elderly population as uninsured. This data was collected prior to the consequences of the economic recession that has been so devastating to Michigan. The Federal poverty level in 2008 for a family of four is $22,025, with 17 % of the population uninsured and another 18% requiring Medicaid, putting them in a category requiring subsidized health care benefits.
Although the Federal bill is titled Health Care Reform, the subsections actually describe insurance reform. The goals for federal and state health care reform are:
• Shared responsibility by employers, consumers, health plans, providers and governments to help cover the costs of reform
• Make health insurance accountable to consumers-with insurance market reforms and health insurance exchanges
• Make health insurance more affordable with the expansion of Medicaid and subsides for insurance premiums
• Reform the health care delivery system to reduce the growth in healthcare costs and to improve access to quality care
The goal of the package of Michigan's bills (HB 6034-6037) matches the federal goals, particularly in regard to affordability and accountability of insurance.
The package of bills authored by the State legislature also match the components of the Federal Health Care bill that will take effect this year (2010). These components are:
• Development of a temporary high-risk pool to include participants with pre-existing conditions-who have not had credible coverage for the past 6 months.
• Extend coverage to dependents up to age 26
• No lifetime insurance limit and no restricted annual limits
• No pre-existing condition exclusions for children
• No cost-sharing for preventive services
• Review increases in health plan premiums
• Provide tax credits for small businesses
• Initiate early retiree re-insurance program
The Michigan package of bills mirror the Federal Health Care Reform bill. What is the purpose of redundant legislation? The State sponsored bills accelerate the time line of some parts of the package. In addition, had the Federal Health Care legislation not passed, Michigan could have provided reform provisions to the citizens of the state. By either bill, there will be a reduction in the number of uninsured, the health insurance system will work better for all, there will be more focus on prevention and primary care and states will play a pivotal role in the implementation.