Michigan and other states are actively competing to become medical tourism destinations. Whether they succeed depends in large part on opening the state’s medical care delivery systems to competition and innovation and tearing down current protectionist barriers. These same reforms will make health care better and more affordable for our own residents too.
What steps are necessary to make this vision real?
Naomi Lopez-Bauman is director of healthcare policy at the Arizona-based Goldwater Institute and adjunct scholar at the Mackinac Center for Public Policy. She has identified what’s needed to bring it about, which the nationwide State Policy Network assembled into a new “toolkit” called “Ten Reforms State Lawmakers Can Implement Now.”
Here’s a quick summary. The full report offers clear explanations of the specific problems we face and how to address them.
1. Establishing Accountability and Transparency in Government Programs
Problem: Government programs to expand insurance coverage including the Affordable Care Act have added layers upon layers of bureaucracy and are often ineffective, inefficient and duplicative, not to mention unaccountable to both patients and taxpayers.
What Michigan Can Do: Before adding any new programs, start by auditing the ones we already have — state, federal and local — to identify who they are supposed to help and how much of the money actually benefits individuals. Then determine how these resources could be used to better meet the needs of those who need help the most.
2. Regain Control of the Health Insurance Market
Problem: Under the ACA states lost control of seven key insurance regulation factors for the individual market, including obtaining and keeping coverage; its cost; coverage mandates; cost-sharing limits; provider requirements and patient protections. Repealing the ACA will not affect these unless state laws are also changed here.
What Michigan Can Do: Lawmakers should review how the ACA was implemented here by state agency actions or new laws and prepare legislation now to take back control if the ACA is repealed.
3. Verifying Medicaid Eligibility
Problem: The number of Medicaid enrollees is skyrocketing, and many who may not be eligible are getting onto the rolls.
What Michigan Can Do: Implement a “robust and timely” verification system that, among other things, cross-matches Medicaid enrollees against other welfare programs. Adopt the best electronic and other tools to “systematically and routinely” verify eligibility.
4. Unwind the Medicaid Expansion
Problem: This state cannot depend on the federal government to keep funding its medical welfare programs at the same rate. The Medicaid expansion did not increase the amount of health care resources available to patients; it simply added additional patients who are less needy than the pre-expansion population. As a result any federal or state cuts to these programs may fall most heavily on those most in need.
What Michigan Can Do: Seek permission from the federal government to freeze enrollments from the less needy Medicaid expansion population. If the feds refuse, roll back eligibility to pre-ACA levels.
5. Increase the Supply of Health Care Providers
Problem: Long before Obamacare became law Michigan was already rationing health care in many ways, including restrictive scope of practice laws on midlevel providers like nurse practitioners, and using a “Certificate of Need” law that gives industry incumbents a say on whether new entrants will be allowed to compete against them.
What Michigan Can Do: Repeal the obsolete and damaging Certificate of Need law that benefits big industry players at the expense of patients and innovators. Eliminate scope-of-practice laws that benefit current providers but make care less affordable and accessible, and slam the door on innovative new ways of bringing health care services to people where they live, work and shop.
6. Protect Telemedicine and other Innovations
Problem: New services are exploding that give patients access to real doctors by video at a very reasonable cost, from the comfort of their own home. But around the country barriers are going up, including requirements for patients to go to a particular location for a video conference, or have a healthcare professional present during one, or get a physical exam before a prescription can be written. These burdens often have nothing to do with patient safety.
What Michigan Can Do: “Lawmakers should protect and empower healthcare innovators, especially when they offer consumers an affordable option to access timely care,” advises the Toolkit.
7. Safeguard Novel Medical Arrangements like Direct Primary Care
Problem: Direct Primary Care is an attractive alternative that lets families or employers enter flat-fee contracts with a doctor for basic services. By eliminating the insurance company middleman for checkups and a range of routine procedures, costs can be dramatically lower and access to your doctor greatly improved.
What Michigan Can Do: Good news: Our legislature already took a huge step by passing a law that excludes Direct Primary Care from the comprehensive and restrictive regulatory regime that governs health insurance. Not-so-good news: A Senate-passed proposal for a pilot program extending the same benefits to Medicaid recipients was crushed by status-quo interests in the House. We’ll get a do-over when the next Legislature takes up the state budget in the spring.
8. Expand Access to Volunteer Care
Problem: Many barriers stand between needy patients and health professionals willing to voluntarily provide free services.
What Michigan Can Do: Michigan could follow a model adopted in Florida, where doctors contract with the state to get protections from lawsuits in return for giving charity care to patients whose incomes are under 200 percent of the federal poverty level. Letting professionals meet continuing education mandates by providing volunteer care is another approach. Michigan should also facilitate charity groups that “parachute in” for large scale weekend clinics free to all comers, such as the Remote Area Medical organization.
9. Give State and School Employees Access to Free Market Health Options
The Problem: Health Savings Plans are popular in the private sector and are saving both workers and employers billions of dollars.
What Michigan Can Do: Nothing prohibits offering the same option to public employees. Legislation has been introduced to allow this in the past but did not advance. It should.
10. Protect Michigan Taxpayers from the ACA ‘Cadillac Tax’
The Problem: It starts in 2018, and every dollar paid to the “Cadillac Tax” is a dollar that won’t go to provide health care services. For family plans, 40 percent will be taken from of every dollar above an insurance premium price of $27,000. As healthcare costs continue to rise faster than inflation this tax will come down on more Michigan residents.
What Michigan Can Do: Our Legislature already passed a law in 2011 that capped state and school employee insurance benefit costs. But the protection has been watered down once, and is vulnerable to further erosion. One way to defend this law is to require that any Cadillac Tax on government employee insurance benefits be paid by the employees themselves, not taxpayers.
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