Governor-elect Gretchen Whitmer has her work cut out for her. Despite historic gains for Democrats and women in Michigan and national midterm elections, Michigan’s legislature retains its Republican majority, and thus presents the new governor with an uphill challenge on all of her initiatives, including her healthcare plan, titled, “Get It Done: Healthy Michigan, Healthy Economy.”

The 19-page document covers a full range of issues facing a state that has low to middling marks on health status, access to care and the cost of healthcare services.

“The state of Michigan has invested very little in public health—just enough to meet what is needed to draw down federal funding,” stated Whitmer in ‘Get It Done.’”

To remedy that state of affairs, Whitmer pledges to “protect Healthy Michigan gains,” from 2014, when then-Gov. Rick Snyder expanded the state’s Medicaid program and helped cut Michigan’s uninsured rate from 18 percent in 2011 to just over 5 percent in 2017. Whitmer made her legislative cooperation with Snyder on this issue one of the focal points of her campaign.

Overall, Whitmer’s plan addresses four main points:
-Making healthcare more affordable
-Expanding access to healthcare
-Improving quality
-Investing in public health

Whitmer looks to reinsurance to better provide for the financial risk of treating Michigan’s high-risk, low-health-status population. Borrowing from other states’ approaches to keeping coverage affordable for “super utilizers of healthcare,” Whitmer proposes “a Michigan reinsurance program (that) would lower costs here as well by preventing insurance premiums from being driven up by over-utilization of our state healthcare system and should be examined in conjunction with a 1332 innovation waiver to pull down federal pass-through savings.”

She cites examples from Alaska, Maryland, Minnesota and Oregon, which she states have had positive results lowering health insurance costs resulting from super utilizers of healthcare and leveraged federal dollars to pay for it. “Oregon brought in $30 million in federal funding for its reinsurance program.16 Alaska drew down $300 million in federal funding over five years to fund its reinsurance program.17 Minnesota has brought in $271 million in federal funding per year. After years of double-digit increases, premiums fell by an average of 15 percent following the implementation of Minnesota’s reinsurance program. In Maryland, average individual market premiums for 2019 are expected to decrease by nearly 14 percent after the state received federal approval to implement a reinsurance program. Without reinsurance, 2019 premiums would have increased by 30 percent.”

Reducing prescription drug costs has been another bellwether issue for candidates on both sides of the aisle. Whitmer quotes National Council on State Governments. ““Prescription drugs account for almost 10 percent of overall health spending in the United States, totaling $263 billion annually.” She added that “prescription spending is the fast growing cost of the health care dollar; in 2015, prescription drugs had the largest price increases in 24 years”
“As governor I will implement transparency standards and strong consumer protections that facilitate better price negotiations between hospitals and the pharmaceutical industry,” stated Whitmer. She cites other states that have adopted transparency laws on prescription drug costs: California requires advance notice of price increases over 16 percent; Oregon requires a pharmaceutical company to disclose corporate profits if a drug’s price increases over 10 percent, and Nevada requires insulin makers to justify price increases. In Vermont, the law requires the pharmaceutical industry to justify price increases on the top 15 drugs that account for the most state spending on prescription medicines.

Whitmer also made extensive use of access issues during her campaign, as did Democrats nationwide. The national flagship issue here is access to healthcare for those with pre-existing conditions, including asthma, cancer, diabetes and other conditions that have made it difficult for sufferers to buy health insurance.

“If protections for pre-existing conditions are repealed by Congress or overturned by a conservative majority on the U.S. Supreme Court, my administration will work to pass legislation here in Michigan that guarantees coverage for people with preexisting health conditions,” she stated in “Get It Done.”

The governor-elect also outlined a nursing scholarship program aimed at addressing a nursing shortage in Michigan.

The new governor is prepared to put her money where her mouth is, pledging significant efforts toward resources for mental health, research, telemedicine and safe drinking water, in part through federal funds and as part of an infrastructure improvement plan.

Of course, funding and support for measures, state and federal, will be an uphill grind for the new governor, who will be working against Republican majorities at home and in Washington. Still, issues such as pre-existing condition protection and drug cost control are rapidly becoming bi-partisan issues, at least rhetorically. Whitmer’s term runs through the 2020 election cycle, so it will be interesting to see what materializes during the second half of her first term.