Patient Centered Healthcare Solution

As part of the Affordable Care Act (aka Obamacare), the Federal government is dangling a promise of partial funding to encourage states to expand Medicaid and there are ongoing discussions in Michigan about how to handle this situation. We need to stop talking about expanding a government program that doesn’t work and start talking about ways to expand affordable care to all of our citizens.

To this end, I’m putting forth a patient-centered healthcare plan that would allow us to capitalize on our free market system and provide better quality, less expensive healthcare to Michigan’s residents while boosting our economy.

The plan’s objectives are based on the stated goals of the Affordable Care Act (ACA) — lowered health plan costs, expanded coverage, improved quality of care and protection of consumer choice — as well as additional factors including: patient-centered care and the ability to attract jobs to Michigan.

Under this patient-centered plan, Michigan would see health coverage extended to low-income citizens, health insurance cost relief to individuals and health insurance cost relief to the business community through a reduction in the cost shift of uncompensated care. This solution requires all health insurance, including the plan offered to our Medicaid population, to be provided via privately administered Qualified Health Plans (QHP’)s.

Under the ACA, insurance providers will need to meet certain requirements in order to sell their QHP’s on the healthcare exchanges. These QHP’s are insurance plans that are certified by the Health Insurance Marketplace, provide essential health benefits, follow established limits on cost-sharing (like deductibles, copayments, and out-of-pocket maximum amounts), and meet other requirements.

A QHP can be insurance, managed services, fee-for-service access or any combination thereof. This flexibility allows us to design a healthcare plan that provides both primary and preventive care, as well as catastrophic care, to our Medicaid population through a combination of plans. This new coverage then becomes portable, meaning the recipient can continue under the plan should their income level change, unlike the current Medicaid system that requires enrollees to move in and out of the system as their circumstances warrant.

As an added benefit, this plan could even help the city of Detroit with its unsustainable, out-of-control costs. This plan would provide a viable alternative to higher cost ACA plans and provide better benefits to city employees at lower costs. This could potentially lower annual healthcare expenses by as much as 50% ($137M) and lower the $5B liability for retiree healthcare by as much as 50% ($2.5B).

To enact this plan, I have drafted a package of bills that would make these sweeping changes in Michigan. The first bill provides the regulatory infrastructure that enables a low cost, high quality care free market environment within the confines of the ACA.  It also features a Low Income Trust Fund that would be limited to “gap insurance” for Medicaid enrollees that invoke the high deductible component of their QHP. The second bill converts the existing Medicaid population to a QHP featuring direct primary care services and a high deductible health insurance plan.

While we are required to make changes to our state’s healthcare delivery system under the Affordable Care Act (Obamacare), we are not required to simply rubberstamp the Federal government’s idea of expanded government provided care. We  can use this as an opportunity to put in place a free market based system that will not only accomplish the objectives of Obamacare but will go even further by recognizing that healthcare delivery is a growth market for Michigan. If we can provide quality services at a greatly reduced cost, we can draw patients from other states and countries who are looking for better access to quality care and create new healthcare jobs in Michigan.