Governor Rick Snyder
September 14, 2011
Health Care Reform
The MI Health Marketplace
I strongly support establishing a Michigan-based on-line health insurance exchange that will emphasize free market principles and serve as a competitive marketplace for individuals and businesses to obtain health insurance, including some of our most vulnerable residents who are currently uninsured.
The Affordable Care Act (ACA) requires each of the states to establish a health insurance exchange by 2014. If Michigan does not establish its own exchange, then the federal government will step in to operate one for Michigan. While I recognize that all or a portion of the ACA may be repealed or found to be unconstitutional in lawsuits that are currently pending, Michigan must be prudent and plan to reach the best possible outcome under the existing law. Because Michigan needs a health insurance marketplace that best serves Michiganders, I am asking the Legislature to adopt legislation to create the MI Health Marketplace. This legislation should both satisfy the requirements of the ACA and improve the experience of purchasing health insurance coverage in Michigan.
I do not support a “one size fits all” federal approach to health reform, which is where we would be if we were to allow the federal government to run a health insurance exchange in Michigan. But even if the act of establishing a health insurance exchange were not mandated by the ACA, I would still be in favor of utilizing technology to create a better customer service experience for Michiganders. Done right, the MI Health Marketplace legislation will allow customers and small businesses to make more efficient and better informed decisions about buying health insurance coverage. When customers are provided with unfettered access to companies, products, pricing, and related information, there is higher confidence in the price and the quality of the products.
To achieve this goal, the MI Health Marketplace must operate under the following set of guiding principles.
- The MI Health Marketplace must empower individuals and small businesses by enabling them to easily compare health insurance options. Giving customers an additional, streamlined tool to compare health care plans will allow Michiganders to more easily find a plan that best fits their needs. Creating a simple, clear system in which individuals and small businesses can compare plans will encourage health insurance carriers to compete for business by keeping costs down and providing high quality coverage.
- The MI Health Marketplace must not add bureaucracy and complexity that increases the cost to customers. As the Legislature develops the MI Health Marketplace, it should focus on creating a structure that is simple and straightforward. It should not create a duplicative regulatory structure for health insurance in Michigan, but should focus on creating an efficient mechanism for customers to easily compare different plans. It should encourage healthy competition rather than simply add new transaction costs to the expenses that individuals and small businesses already face. The MI Health Marketplace should be established as a non-profit entity, existing outside of the government rather than another level of government bureaucracy.
- The MI Health Marketplace should be another tool for health insurance customers, but not be the only available option for purchasing health insurance coverage. While the MI Health Marketplace will enhance the market for health insurance in Michigan, it should not be the only available option for customers. Many Michigan businesses and individuals are pleased with their current health coverage and have been well served by the current system. The MI Health Marketplace should not force these satisfied customers onto to a health insurance exchange that they do not need.
- The MI Health Marketplace must be customer-service oriented, accountable, reliable, transparent, and expedient. Excellent customer service must be a hallmark of the MI Health Marketplace. Unlike other sectors of our economy, our health care system has not adopted many technological advances, especially for customers to interact with the health system. Today we can use a smart phone to make reservations at restaurants, pay bills or even make major purchases for our homes. But finding affordable health coverage or even having access to your medical records continues to be a real challenge that technology has not yet been fully tapped to address. Moreover, unlike other sectors of the economy, such as retail or shopping for car insurance, the customer service experience in health care is often frustrating. By using technology, the MI Health Marketplace can make the on-line experience of selecting and purchasing health insurance coverage as easy as selecting and purchasing travel arrangements through websites like Travelocity and Orbitz. This design will incentivize insurance carriers to work hard to earn your business by offering innovative products that strive to control costs and improve quality. The MI Health Marketplace must also be accountable and transparent, by being made subject to the Open Meetings Act and the Freedom of Information Act. The operating costs should be available for public review through simple and reasonable reporting requirements.
These recommendations have been developed through a process of consulting stakeholders in the health care industry, including consumers, employers, health plans, a diversity of health care providers, insurance agents and brokers, labor, local governments, and universities. The Department of Technology, Management, and Budget has developed a technology plan that would allow for the seamless integration of the commercial health insurance products offered on the MI Health Marketplace with new state Medicaid eligibility rules mandated by the ACA. The new technology will establish a MI Health Marketplace portal with a single point of entry for individuals and employers to access information about health care coverage. The internet portal will enable insurance plan shopping and comparisons, validate eligibility and demographics, and enable insurance plan enrollment and payment. We will take all steps necessary to safeguard customer privacy and confidentiality. This plan will leverage existing state technical systems to the extent possible and be funded, to a large extent, by federal grants.
In order to meet the rigid federal guidelines for states to establish their own health insurance exchanges, and to utilize the federal funding, I urge the legislature to enact legislation creating the MI Health Marketplace before this Thanksgiving. Moving quickly will also put Michigan in a position to shape the development of federal health care reform.
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Governor Rick Snyder
July 3, 2012
Following the Supreme Court's decision on the Affordable Care Act, a firestorm of cries erupted from across the country calling for swift action to repeal the law, and that anger is understandable. The health care law fails to make important reforms needed in our health care system, has been a serious detriment to our economic recovery, and imposes significant new taxes on businesses and the American people. But with the Court's decision, it is my responsibility as governor to ensure that the people of our state are protected from even greater overreaches by the federal government. That is why it is vital that we move forward and implement our own health insurance exchange before Washington imposes one upon us.
Health insurance exchanges are marketplaces where people can choose from a variety of health care plans offering different features. Think of it like Travelocity, Expedia or Orbitz, where you can log-on to your computer, search for airline flights, and pick the one that's best for you. Today, Michigan has the opportunity to design our own health care exchange — and we can create one that works for the people of Michigan and is not an undue burden on job providers. That's not something we can achieve if we sit back and wait for the federal government to take control.
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March 18, 2013
Applying for Obama health care plan won't be easy
Washington — Applying for benefits under President Barack Obama's health care overhaul could be as daunting as doing your taxes.
The government's draft application runs 15 pages for a three-person family. An outline of the online version has 21 steps, some with additional questions.
Seven months before the Oct. 1 start of enrollment season for millions of uninsured Americans, the idea that getting health insurance could be as easy as shopping online at Amazon or Travelocity is starting to look like wishful thinking.
At least three major federal agencies, including the IRS, will scrutinize your application. Checking your identity, income and citizenship is supposed to happen in real time, if you apply online.
That's just the first part of the process, which lets you know if you qualify for financial help. The government asks to see what you're making because Obama's Affordable Care Act is means-tested, with lower-income people getting the most generous help to pay premiums.
Once you're finished with the money part, actually picking a health plan will require additional steps, plus a basic understanding of insurance jargon.
And it's a mandate, not a suggestion. The law says virtually all Americans must carry health insurance starting next year, although most will just keep the coverage they now have through their jobs, Medicare or Medicaid.
Some are concerned that a lot of uninsured people will be overwhelmed and simply give up.
"This lengthy draft application will take a considerable amount of time to fill out and will be difficult for many people to be able to complete," said Ron Pollack, executive director of Families USA, an advocacy group supporting the health care law. "It does not get you to the selection of a plan."
"When you combine those two processes, it is enormously time consuming and complex," added Pollack. He's calling for the government to simplify the form and, more important, for an army of counselors to help uninsured people navigate the new system. It's unclear who would pay for these navigators.
Drafts of the paper application and a 60-page description of the online version were quietly posted online by the Health and Human Services Department, seeking feedback from industry and consumer groups. Those materials, along with a recent HHS presentation to insurers, run counter to the vision of simplicity promoted by administration officials.
"We are not just signing up for a dating service here," said Sam Karp, a vice president of the California HealthCare Foundation, who nonetheless gives the administration high marks for distilling it all into a workable form. Karp was part of an independent group that separately designed a model application.
The government estimates its online application will take a half hour to complete, on average. If you need a break, or have to gather supporting documents, you can save your work and come back later. The paper application is estimated to take an average of 45 minutes.
The new coverage starts next Jan. 1. Uninsured people will apply through new state-based markets, also called exchanges.
Middle-class people will be eligible for tax credits to help pay for private insurance plans, while low-income people will be steered to safety-net programs like Medicaid.
Because of opposition to the health care law in some states, the federal government will run the new insurance markets in about half the states. And states that reject the law's Medicaid expansion will be left with large numbers of poor people uninsured.
HHS estimates it will receive more than 4.3 million applications for financial assistance in 2014, with online applications accounting for about 80 percent of them. Because families can apply together, the government estimates 16 million people will be served.
Here are some pros and cons on how the system is shaping up:
Pro: If you apply online, you're supposed to be able to get near-instantaneous verification of your identity, income, and citizenship or immigration status. An online government clearinghouse called the Data Services Hub will ping Social Security for birth records, IRS for income data and Homeland Security for immigration status. "That is a brand new thing in the world," said Karp.
Con: If your household income has changed in the past year or so and you want help paying your premiums, be prepared to do some extra work. You're applying for help based on your expected income in 2014. But the latest tax return the IRS would have is for 2012. If you landed a better-paying job, got laid off, or your spouse went back to work, you'll have to provide added documentation.
Pro: Even with all the complexity, the new system could still end up being simpler than what some people go through now to buy their own insurance. You won't have to fill out a medical questionnaire, although you do have to answer whether or not you have a disability. Even if you are disabled, you can still get coverage for the same premium a healthy person of your age would pay.
Con: If anyone in your household is offered health insurance on the job but does not take it, be prepared for some particularly head-scratching questions. For example: "What's the name of the lowest cost self-only health plan the employee listed above could enroll in at this job?"
HHS spokeswoman Erin Shields Britt said in a statement the application is a work in progress, "being refined thanks to public input."
It will "help people make apples-to-apples comparisons of costs and coverage between health insurance plans and learn whether they can get a break in costs," she added.
But what if you just want to buy health insurance in your state's exchange, and you're not interested in getting any help from the government?
You'll still have to fill out an application, but it will be shorter.
Michigan To Become The Travelocity Of Obamacare For A Mere $10m. Are These Subscribers Medically Underwritten?
Lets clear up one very large myth here that the Detroit News and other rush to market exchange proponents are propagating that can cause irreperable harm. A travelocity style health exchange cannot be designed, planned, implemented and operated for $10m. That grant money doesn't even begin to cover the planning and pilot of the mechanics behind the scenes of allowing Michiganders to hook into the state of Michigan (.gov) site and conduct the Medical Underwriting that is needed to issue a policiy, maintain the subscribers and do claims processing.
It wouldn't be so laughable if the Detroit News and other media outlets were showing their naievity on what a healthcare exchange really involves. Stop, take a step back and realize that in the long run this exchange is bigger than the new bridge in terms of complexity and yet in a rush to implement many are treating this like a Senior Science Project
July 5, 2012
Editorial: Michigan House Republicans can't keep delaying state health care revisions
Some House Republicans are tempted to continue delaying approval of a Michigan-based version of the health insurance exchange required under the 2010 federal health care act, in spite of a recent U.S. Supreme Court decision upholding the law. That would be a disservice. It's now time to put aside wounded feelings and approve the minimalist, market-based plan developed by Gov. Rick Snyder and passed by the Senate in November.
House Speaker Jase Bolger, R-Marshall, indicated to The Detroit News that in the wake of the 5-4 Supreme Court decision, he intends for his caucus to end its eight-month holdout and reluctantly forge ahead with voting on the Senate legislation. That's not only a proper statesman-like reaction to the ruling, but it recognizes that the odds against overturning the so-called "Obamacare" act have now become longer.
At the same time, Bolger's spokesman said there's no official Republican caucus position on when the House votes will be taken. Rep. Gail Haines, R-Lake Angelus, muddied the waters by claiming the House GOP may yet decide to do nothing until after the November election, in hopes Mitt Romney and Republicans might seize control of the federal government and kill the health care act.
Attorney General Bill Schuette, letting his political stripes outshine his role as the state's top legal adviser, is urging Republicans to continue stalling. He, of course, is state campaign co-chairman to Romney, who has vowed he'd do his best to repeal the health law if elected president.
Schuette is offering bad advice on several counts. First, Snyder's proposed Travelocity-style website, where consumers could shop for health insurance to meet their needs and budgets, would be good for Michigan irrespective of the federal law. Michiganians who lack insurance, whether individuals or smaller businesses, may want to avail themselves of the service and should be given that opportunity.
Second, there's no guarantee Obamacare will be repealed even if Romney wins. Republicans would also have to retain control of the U.S. House and not just wrest the U.S. Senate away from Democratic control, but win a super-majority capable of overcoming the inevitable filibuster. But if Obamacare is dealt with via the reconciliation process, only a simple majority would be needed.
Finally, time is running out on Michigan's ability to chart its own course. If the state fails to have its version of an insurance exchange up and running by only about a week past the Nov. 6 election, the federal government is required to step in with what's almost certain to be a costlier and more bureaucratic setup. There's already some doubt Michigan will be able to get all the necessary pieces in place by then.
Michigan is also in danger of losing a $9.8 million federal planning grant that would cover the cost of developing the web-based exchange Snyder envisions. Lawmakers have blocked the Snyder administration from accepting the grant, which expires Sept. 29. The Legislature, in summer recess now, has just 10 session days scheduled between now and Nov. 6.
Out of frustration, Snyder and his advisers have started considering a partnership with the federal government to run an exchange here. The state would handle some responsibilities, such as customer service, but the feds might have a bigger role.
It shouldn't come to that. Snyder and the Senate have mapped out a strategy for satisfying federal requirements while bolstering competition and consumer choice in the private health insurance marketplace. The House should waste no more time passing and sending the legislation to the governor for his signature.
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