Lansing Lines is presented in cooperation with MIRS, a Lansing-based news and information service.
DHHS Issues More COVID Orders; Mac Center Questions Validity
The Michigan Department of Health and Human Services issued more emergency orders Oct. 6 in reaction to the Supreme Court ruling Oct. 2 that struck the law on which the governor had issued similar executive orders.
DHHS Director Robert Gordon signed one order that maintains protections for people in residential and congregate care as well as juvenile justice facilities. Another one requires K-12 schools to provide public notice about probable and confirmed cases of COVID-19 within 24 hours.
The order on residential care continues restrictions on visitation to residential care facilities, which include nursing homes, homes for the aged, adult foster care, assisted living, and independent living, according to the state.
Outdoor visits are permitted with precautions, such as allowing for at least six feet separation between all people, and communal dining is permitted under the order at all facilities consistent with the Center for Medicare and Medicaid Services and DHHS guidance.
The order also covers notification requirements involving COVID-19 cases for these facilities.
There are different visitation rules for child caring facilities and juvenile justice facilities. In those cases, the facilities may allow visitors as long as they provide information about COVID-19 prevention practices and symptoms of the virus. Visitors will need to enter through a designated entrance and be screened for COVID-19 symptoms. Also, they will be limited to designated areas and schedule their visit in advance.
On the school order, it requires local health departments to notify schools within 24 hours of learning of a probable or confirmed school-associated case of COVID-19.
After that, schools must provide public notification on a highly visible location on the school’s website that covers the affected building or location within 24 hours, according to a press release issued by the state.
That order goes into effect on Oct. 12.
Gov. Gretchen Whitmer said the DHHS order that replicates, in part, some of her mask requirements and gathering restrictions can not only be extended beyond Oct. 30 but that she expects it to be extended until “we have some comfort” that there’s a handle on the disease.
The Mackinac Center, which brought the suit the MSC opined on against Whitmer, said that with respect to the DHHS orders, “encouraging a state agency to issue these rules is clearly an attempt by Gov. Whitmer to sidestep” the MSC ruling. It added later that the law that the DHHS is using “also lacks clear limitations on its use, the same problem that plagued the 1945 law that the Michigan Supreme Court just struck down as unconstitutional.”
Michael van Beek, the Mackinac Center’s director of research, said the 1945 law had no limit as to when Whitmer’s executive order expired. The same could be said for what Gordon is doing. This law, too, would seem to be “broadly worded” and “ill-defined.”
The governor argued her actions under the law up to this point were not unlawful and that she “interpreted this law correctly.” It was the Legislature in 1945 that made a mistake in extending that power to the governor, she said.
The Michigan Freedom Fund (MFF) said Whitmer responded to the Supreme Court’s call to work with lawmakers “by lobbing insults at the Court and launching partisan attacks against her legislative partners at a time when residents need partnership, not politics.
MFF Executive Director Tony Daunt said, “the state is scrambling today as a direct result of her illegal, unconstitutional leadership over the last half year—not the Legislature’s.”
Meanwhile, the state reported 903 more COVID-19 cases and 22 more deaths for 129,826 cases and 6,838 deaths total as of Oct. 6.
Mask Mandate Called ‘Muzzle Order’ In New Federal Suit
An Oregon woman who works in Michigan filed a federal lawsuit Sunday against the state’s Attorney General that challenges the governor’s executive order mandating masks in public. The suit may end up getting amended since its now a Department of Health and Human Services order, as well as some health department orders that mandate the masks.
The Michigan Supreme Court ruled Oct. 2 that Gov. Gretchen Whitmer’s executive orders violated the 1945 Emergency Powers of Governor Act, and she has since asked the court to clarify when their ruling takes effect.
Huguette Nicole Young, of Junction City, alleges the mask mandate violates her First Amendment right of free speech by “literally blocking (her) ability to speak audibly and clearly while wearing a face mask, so much so that many like plaintiffs who are rightfully offended by blanket face mask orders (that appear, in the absence of transparency, to be based mostly on political power grabbing in the face of unjustified hysteria) refer to face mask orders under these conditions as muzzle orders.”
Young’s suit, filed in U.S. District Court Eastern District, claims “experts have known COVID-19 is not a pandemic since February” and that scientists “should know better” than to “mislead the public into believing COVID-19 is a public health emergency.”
Young alleges the mask mandate will violate her First Amendment right when she is “forced to wear a face mask at any Walmart store along” Interstate 75 in Eastern Michigan when she shops while working in Michigan.
Young seeks an order barring Attorney General Dana Nessel from enforcing any mask mandate.
House, Senate Will Return To Session To Deal With COVID
The Michigan House will be coming back to session to deal with the COVID-19 pandemic now that the Supreme Court has ruled the governor lacks authority to continue issuing executive orders, House Speaker Lee Chatfield (R-Levering) said Oct. 5 in an online press conference.
“This is what the Legislature has been advocating for and calling for this entire time. We believe that we can find common ground . . . We will be taking COVID seriously to do all we can to keep the people of Michigan safe. This is not a political fight and COVID 19 does not discriminate between Republicans and Democrats and neither should we,” Chatfield said.
He did not give a time for when the House would return. More information apparently is coming.
The next session day scheduled is Oct. 21, but Chatfield and Senate Majority Leader Mike Shirkey (R-Clarklake) have the ability to call their members back into session before that.
Rep. Beau LaFave (R-Iron Mountain) did test positive for COVID, but a House spokesperson said his illness will not impact the House schedule.
Chatfield also contended Gov. Gretchen Whitmer was wrong to ask for a 21-day stay to the Supreme Court’s order. He said the orders were unconstitutional in May and they still are in October.
Rep. Donna Lasinski (D-Scio Twp.), the chair of the House Democrats’ campaign committee, said on the MIRS Monday podcast the House “absolutely” must return to address the Supreme Court opinion.
Beaumont Ends Merger Talks With Wisconsin Hospital
The Beaumont hospital system announced in early October it has ended discussions on its controversial merger with Milwaukee-based Advocate Aurora Health.
Attorney General Dana Nessel’s announced in July that a team was reviewing two proposed transactions, including the Beaumont’s approval of a non-binding letter of intent to merge with Advocate.
Nessel spokesperson Ryan Jarvi said the office had no comment on the status of that investigation or on today’s announcement.
Beaumont CEO and President John Fox said in a call with reporters that merger discussions in the pandemic “greatly hindered interpersonal interactions,” which were essential to building relationships and allowing the two hospital systems “to get to know each other.”
“We discussed it; we agreed it would be a mutual decision,” Fox said, noting that addressing the pandemic is more of a priority than merger talks.
Oakland County Executive David Coulter and U.S. Rep. Debbie Dingell (D-Dearborn) both said halting the partnership was the right decision.
Dingell, who along with U.S. Rep. Rashida Tlaib (D-Detroit) sought additional information on the proposed merger, said it was known “from the start there were serious concerns.”
In a statement, Dingell said she was “glad that the concerns that were raised in a letter from myself and Congresswoman Tlaib have been heeded” and that “Beaumont plays a key role in providing healthcare to southeast Michigan, including in my district, and it must live up to its longstanding reputation for providing quality health care to the communities it serves.”
Coulter said he looked forward to Beaumont’s “renewed focus on ‘local market priorities.'”
Among the concerns, Fox acknowledged, was Beaumont’s staff and physicians as well as the community’s feelings.
“Over the past few months, we have listened to the perspectives of many physicians, nurses, staff, donors, elected officials and community members about a variety of topics and their concerns about a potential partnership with Advocate Aurora, and we very much appreciate their candidate feedback,” he said.
Beaumont, which operates eight hospitals, also ended a planned partnership with Akron, Ohio-based Summa Health. The two hospital systems signed a definitive agreement in December 2019 and received all necessary state and federal regulatory approvals before announcing in May the end of the proposed partnership.
Advocate was formed through a 2018 merger of Chicago-based Advocate Health Care and Milwaukee-based Aurora Health Care, according to its website.
MI Has Highest Death Rate Among Midwestern States
Senate Republicans Oct. 1 recycled a quote from Sen. Aric Nesbitt (R-Lawton) from late September in which he said Michigan has the highest coronavirus death rate in the Midwest. But is it true?
On Twitter Oct. 1, Senate Republicans tweeted,”@SenAricNesbitt: What have @GovWhitmer’s HUNDREDS of contradictory executive orders gotten us? A #COVID19 death rate higher than anyone else in the Midwest.”
In fending off a Twitter reply from someone who said, “Nesbit is a liar,” the Senate Republicans cited this website, which has Michigan slightly ahead of Illinois as of today at 71 to 70 for Illinois in deaths per 100,000 people.
The New York Times’ deaths-per-100,000-people stats show Michigan with 71 per 100,000 people. As of Oct. 1, Michigan was tied with Illinois for most among the states most commonly included in the Midwest.
As for the other Midwestern states and their death rates, The Times has Indiana at 54 per 100,000 people, Ohio at 41, Minnesota at 37 and Wisconsin at 23.
Nationally, Michigan is ranked 10th by The Times for deaths per capita overall. New Jersey is at 182 per 100,000, and it’s followed, in order, by New York, Massachusetts, Connecticut, Louisiana, Rhode Island, Mississippi, Washington, D.C. and Arizona.
Michigan was ranked sixth on this list on May 1. Back in late April, Michigan was ranked third among the states in total deaths.
Asked to provide some more context for the higher death rate than other Midwestern states, Lynn Sutfin, spokesperson for the Michigan Department of Health and Human Services, provided three things to consider.
First, at the beginning of the outbreak, she said, the state followed fed guidance on prioritizing testing for people under investigation, leading to targeted testing among higher risk groups that were more likely to have COVID exposure. Hospitalized people were also targeted for prioritized testing.
Second, an order issued by DHHS in March required mandatory reporting of COVID-19 deaths within 24 hours, which “led to enhanced reporting that may not be happening in other states,” Sutfin said.
Finally, Sutfin said the state is regularly reviewing death certificate data maintained in vital records reporting systems, and if a record shows COVID-19 contributed to death, that record is compared to lab-confirmed COVID-19 cases in the Michigan Disease Surveillance System (MDSS). If the death certificate is matched to a COVID-19 case and the record in MDSS doesn’t indicate a death, then that record is updated.
But Michigan has been doing better recently when it comes to COVID deaths.
When it comes to deaths per capita in the past seven days, Michigan is at 0.7 per 100,000, below places like Guam at 7.1, North Dakota at 5.8 and Arkansas at 4.6.
And out of the Michigan’s 7,102 deaths reported in a state data set as of Oct. 1, 83 percent of them, or 5,938, came from March to May, including three deaths dated before March tied to COVID-19.
The accompanying video on the Senate GOP tweet replayed comments Nesbitt made at a prior meeting of the Joint Select Committee on the COVID-19 Pandemic.
In the committee meeting, DHHS Director Robert Gordon said that with respect to comparing Michigan to other Midwestern states, Detroit’s international airport made it a receiving point for international flights. Nesbitt countered by saying Chicago has one that is twice as big yet Illinois death rate is lower, although not a lot, he said at the time.
Oct. 1, the state reported 891 more cases and 19 more deaths for cumulative statewide totals of 125,578 cases and 6,781 deaths due to COVID-19.
‘Surprise Medical Billing’ Ban Clears Senate
“Surprise medical billing,” a practice in which out-of-network providers charge for services beyond what is covered by a patient’s health insurance, would be outlawed under a four-bill package approved by the Senate Sept. 30.
This may happen when a patient receives treatment at an in-network facility and inadvertently receives treatment from a provider — such as an anesthesiologist or radiologist—who is not in-network. It can also happen when a patient visits an out-of-network facility in an emergency.
The main bill passed the Senate Sept. 30, 32-6, but the package is not popular with some in the health care field.
Sen. John Bizon (R-Battle Creek), the only medical doctor in the Legislature, was a no vote and said the issue is one of network adequacy.
“If we buy insurance, we anticipate that it is for 24/7. When insurance companies are saying that they have provider networks, surprise bills say that their networks are not 24/7 networks, but part-time networks. I think we need more work in making sure that there is greater communication and transparency within the system,” Bizon said.
The fact that some providers can charge patients more can provide an incentive for providers to stay out of network, critics of the practice argue.
“I was in private practice and I would be getting a contract from an insurance company for participation in their network. It would be thrown on my desk and it was a take-it-or-leave-it thing. There was no discussion. There was no negotiating whatsoever. If that is the way they treat the anesthesiologists, I can understand why they don’t have participation,” Bizon said.
Rep. Roger Hauck (R-Union Twp.) and Rep. Frank Liberati (D-Allen Park) have proposed four bills — HB 4459, HB 4460, HB 4990 and HB 4991—to the end practice.
Under the package, a nonparticipating provider would have to accept from the patient’s insurance either 150 percent of the fee Medicare would pay for the service or the median the insurer or other providers in the region, whichever was greater.
Two former senators and doctors, Roger Kahn and Tom George, have issued a letter to the Senate saying they believe the fixes proposed in the package “will dramatically confuse and frighten patients by placing them in the middle of billing disputes between insurers and providers.”
“It is stunning to call it a ‘billing fix’ when it will require patients to know the meaning of disputed insurance codes, transmit insurance payments and understand the mechanics of dispute resolution,” the joint letter states. “Instead of addressing the root causes of surprise billing, the proposed legislation is going to make billing payments more difficult to understand and the resolution of disputes even more complex.”
It says HB 4459 proposes that insurance companies reimburse patients directly instead of working out bills and disputes with health care providers, “and puts our citizens squarely in the middle.”
Blue Cross Blue Shield of Michigan, on the other hand, likes the legislation, saying it protects patients from surprise bills by having the largest network in the state.
“Our members who receive in-network services should never receive a surprise bill. When surprise billing occurs, it places a significant burden on individuals and families. We stand behind these bills, as eliminating the practice of surprise billing and enhancing disclosure and transparency is a much needed policy change,” said Blue Cross vice president for corporate communications Andy Hetzel.
In the 32-6 vote on HB 4459, the no votes were Bizon, Sen. John Bumstead (R-Newaygo), Sen. Ruth Johnson (R-Holly), Sen. Peter MacGregor (R-Rockford) and Sen. Rep. Jim Runestad (R-White Lake).
HB 4460 passed 36-2 with only Bizon and Sen. Ed McBroom (R-Vulcan) opposing.
Bizon was the only no vote on HB 4990 and HB 4991, which passed 37-1.