Nationwide, nearly three of every five voters in this year’s
election want at least part of the new federal health care law repealed, and
four of every five Republican voters favor outright repeal. While
Governor-elect Rick Snyder and state legislators cannot repeal a federal law,
there are steps they can take to delay or mitigate for the state the worst
aspects of the Patient Protection and Affordable Care Act (PPACA).
Attorney General-elect Bill Schuette has already made an important
contribution with his pledge to continue Michigan’s participation in the
multi-party lawsuit against the individual mandate and federal control of
already stressed state budgets. Here are some specific steps the governor and
Legislature can take.
Legislators, for their part, could add Michigan to the growing list of states that have protected their residents’ right to decide how they get health care.
Stop Federal Grants: Gov. Snyder can add his support to the
lawsuit for the rhetorical value, but more important will be his management of
the executive branch. Outgoing Minnesota Gov. Tim Pawlenty ordered state
agencies not to seek federal grants related to the health care overhaul and to
delay its state implementation. Gov. Snyder can do the same by requiring that
any departmental grant applications related to health care get his explicit
No Exchange: Looking ahead to 2014, Gov. Snyder can mitigate
one of the new law’s biggest burdens by choosing not to create a state health
insurance “exchange,” instead allowing the federal government to step into that
breach. The federal insurance mandates are so onerous that no amount of
state-level tinkering with the details of the exchange may be able to save
residents’ ability to purchase reasonably priced health insurance.
Because of the new law, employers and
individuals already are facing higher premiums, searching for new policies
because their insurer has either dropped their policy or gotten out of the
market altogether, or are getting refunds in anticipation that their policies
won’t exist in a few years (and so require smaller future claim reserves). The
promise that “If you like your current insurance you can keep it” doesn’t apply
if it’s no longer available.
Opt Out of Medicaid: Regardless of whether the state or the federal government runs the
“exchange,” Michigan could save more than $30 billion between 2013 and
2019 by dropping its Medicaid program. Current recipients would actually get
better insurance and expanded access to care if transferred to the federally
subsidized coverage provided through the exchange.
Exiting Medicaid would also alleviate a
burden on hospitals, since Medicaid recipients end up in the emergency room
more often than the uninsured and nearly three times as often as people with
Guarantee Choice: Legislators, for their part, could add Michigan to the growing list of
states that have protected their residents’ right to decide how they get health
care. Missouri, Montana, Oklahoma and Virginia either have a law or a
constitutional amendment modeled on Arizona’s Freedom of Choice in Health Care
Act. If it survives inevitable legal challenges, the measure would prohibit
authorities from penalizing individuals for choosing to be uninsured or paying
for care a different way, and would also protect doctors from penalties based
on how they get paid for their services. Regardless of federal court rulings,
putting the measure into the Michigan Constitution would also prevent future
legislatures from imposing a state-level individual insurance mandate, or a
Canada-like ban on private medicine.
Require Legislative Approval: Legislators should revive the separation of powers by passing a bill
that forces the key decisions on a state health insurance exchange, insurance
regulations and Medicaid changes to get legislative approval in addition to the
governor’s signature. Outside industry groups are already working with
executive agencies to lay the groundwork for these regulations, so the new
Legislature should act quickly.
Question Authority: Finally, legislative committees need to get answers from the Obama
administration and state health care officials on the broad implications of the
new law for Michigan and the state budget, particularly Medicaid. Legislators
need to hear from constituents who have lost their insurance, employers who are
paying higher premiums, insurers that are dropping specific lines or exiting
the business altogether, and doctors who are opting out of insurance. The
committees should also bring in policy experts who can explain the
market-based, patient-directed policy changes that would accomplish the stated
goals of the current law.
These stories and alternatives should
finally receive the hearing they were denied during the congressional rush to
thwart the will of voters.
Joseph Coletti is director of Health and Fiscal Policy Studies at the
John Locke Foundation, a state-policy think tank based in North Carolina. The
Mackinac Center for Public Policy is a research and education institute
headquartered in Midland, Mich. Permission to reprint in whole or in part is hereby granted, provided
that the author and the Center are properly cited.