Bill To Relax Public Employee Health Insurance Moves
Public employee unions would have more ability to collectively bargain their members’ health insurance costs under legislation that moved early last month in the Senate on a party-line vote and, later in the day, in the House.
In response to local government employees and teachers getting fed up with soaring health insurance costs, Sen. Kevin Hertel (D-St. Clair Shores) sponsored bills (introduced before the hunting break) that give some flexibility to what’s known as the “80/20” and “hard cap” options.
The revamped versions of SB 1129 and SB 1130 address the same issue as bills that moved out of a House committee last week, but are not the same.
“By taking swift action on this critical issue, the legislators have taken a critical step in reigning in skyrocketing health care costs for Michigan teachers and school support staff, which can keep the best and brightest educators working in our local schools and helping our students learn,” said Michigan Education Association President and CEO Chandra Madafferi.
“Our students deserve to have great educators in every school, and we can only do that by allowing school districts to offer competitive wages and benefits that can keep talented educators in the profession.”
Meanwhile, the House passed HB 6058 , sponsored by Rep. Mai XIONG (D-Warren), which was basically the two Hertel bills smashed together.
When the Xiong bill passed the House, several red-shirt public employees clapped as Rep. Laurie Pohutsky (D-Livonia) brought down the gavel. The chambers will need to sort out which version gets sent to the Governor.
Passage of the bill was lauded by Michigan Education Association and MEA President Chandra Madaferri who said it would keep “the best and brightest educators” working in Michigan.
“Our students deserve to have great educators in every school, and we can only do that by allowing school districts to offer competitive wages and benefits that keep talented educators in the profession,” Madafferi said.
At issue is a 12-year-old law that gives public employers the choice between a hard cap on the amount they can pay on employee health insurance or no more than 80% of the total costs. The employee would need to cover the other 20% of the costs.
Due to health care costs rising well over inflationary rates, labor groups argue that employees working under the hard cap system and the 80/20 option are paying more out of their own pockets for health care, and the employer can’t do anything about it.
Hertel’s SB 1129 sets the minimum a public employee can pay in employee health care costs at 80% of the total annual costs of the medical benefit, basically making 80% the floor as opposed to the ceiling. The substitute does not gradually ratchet up that 80% to 81.5% by 2029 as the original bill did.
Hertel’s SB 1130 sets new hard cap numbers for those public entities that are operating under that system and then instructs the state Treasurer to adjust those numbers annually based on the average increase in health insurance rates or 3 percent, whichever is greater.
The two bills are tie-barred together. The Xiong bill is the two Hertel bills put together.
Medicaid Bills For Pregnancy, Infant Coverage Pass Senate
Expanded Medicaid coverage guidelines for pregnancy and infant care, including paying for human donor milk, passed through the Legislature this month.
SB 1056 , sponsored by Sen. Erika Geiss (D-Taylor), SB 1057 , sponsored by Sen. Sylvia Santana (D-Detroit), and SB 1058 , sponsored by Sen. Sarah Anthony (D-Lansing), passed the Senate early this morning. The Santana-backed bill was also tie-barred to HB 5636 , sponsored by Rep. Laurie Pohutsky (D-Livonia), that passed through the House this month.
The Geiss-backed bill would allow for milk from a human donor to be paid for by Medicaid for up to two years if there is a prescription if milk cannot be provided by the mother, or if the infant was born before 34 weeks and weighed less than roughly 4 pounds.
The Anthony-backed portion of the package would require Medicaid to cover ultrasounds and fetal nonstress tests performed at home or through telehealth. The remote ultrasounds and nonstress tests need to be approved by the Food and Drug Administration and comply with federal HIPAA regulations.
Medicare would cover perinatal, OB-GYN services, and licensed midwives or nurses under the Santana-backed bill.” The places named to be covered by the insurance included birthing centers, which tie-barred the bill to the Pohutsky-backed House bill.
Drug Program Protected For Hospitals But It’s Now Connect To This . . .
Legislation preventing pharmaceutical companies from scaling back their participation in a federal program initially created to help low-income patients passed the Senate this month with a companion bill barring hospitals from collecting patient debt if they have not been transparent about their pricing structure.
The “340B” drug availability program, which PhRMA claims hospitals are now using to help keep operations going, can not be limited under SB 1179 , which passed on a 30-3 vote.
However, the bill passed with a companion bill from a conservative Sen. Jonathan LINDSEY (R-Brooklyn), SB 952 , that says a hospital must forgive any customer debt if it’s shown that it is not transparent about how much the service it’s collecting on cost. That bill passed unanimously.
Still, the bill was opposed by the chair of the Senate appropriations subcommittee overseeing the Department of Health and Human Services, Sen. Sylvia Santana (D-Detroit), because it’s exacerbating a funding stream problem that needs to be adjusted by the federal government, which created 340B to begin with.
Because of this, Michigan’s larger hospital systems have found ways to use the program in other areas that have nothing to do with making sure patients of limited means have access to medication.
“What we’re doing is unethical. What we’re doing is not providing that care where it should be. What we’re doing is just taking our rural hospitals and putting them in an adverse situation,” Santana said.
Santana said 340B was a pharmaceutical program designed by the federal government to help with the AIDS epidemic, to make sure that those who didn’t have the means to pay for prescription drugs could work with the manufacturer, the hospital and the clinics to get the drugs. Many of those who were on the program did not have insurance.
Over time, the program has expanded to the point that of the $54 billion spent last year on 340B, only 2% went back to helping support those who are underinsured or need help with their prescription drugs, she said.
For the state’s small hospitals, however, the money that comes from what they charge pharmaceutical companies participating in the 340B program has become critical.
So much so, Sen. Ed McBroom (R-Waucedah Twp.) offered an amendment that when a provider has multiple facilities, that they be permitted to have at least two pharmacies in each county where they have a presence. This would help the clinic that purchased the recently closed Ontonagon County hospital, he said. But in the end, his amendment was defeated.
Santana, Sen. Mark Huizenga (R-Walker) and Senate Minority Leader Aric Nesbitt (R-Lawton) made up the three no votes on SB 1179 , sponsored by Senate Majority Floor Leader Sam Singh (D-East Lansing).
Medicaid Could Be Used To Pay For Gun Violence Experts Under Bill
Counselors who work with victims of gun violence in hospitals would be paid for their time with Medicaid dollars, under legislation that moved out of the House Health Policy Committee this month.
Community violence interventionists (CVI) are currently volunteers who talk with those injured by gun shots to work them through the situation and dissuade them from trying to continue a cycle of gun violence in a community.
Currently, people like Yafinceio Harris, known in the Kalamazoo community as “Big B,” are volunteers. Neither the police nor the hospitals have the money to pay them for their time, but Dr. Brian Stork, a physician who has made gun violence prevention a passion, said these folks can make a big difference in talking people out of retaliatory actions.
Rep. Brenda Carter (D-Pontiac) and Rep. Karen Whitsett (D-Detroit) both praised HB 6046 as a needed way to encourage more CVIs into the areas of high gun violence and were among the entire Democratic caucus, which voted to move them to the House floor. Republicans passed on the vote.
In other news from the House Health Policy Committee:
– Legislation requiring Medicaid and private health insurers to cover the costs of extended care for children with severe breathing issues or other complexities that require them to receive 24/7 care moved out of the committee with Democratic votes.
HB 5974 , HB 6152 and HB 6153 is a bipartisan package that advocates say is necessary for those families who have limited options in caring for their children living with medical complexities.
Insurance Coverage For O-T-C Birth Control Passes; More Senate News
Insurers in Michigan must cover over-the-counter birth control and emergency contraception without a prescription being needed for coverage starting in 2026, under legislation approved in the Senate this month.
The Senate approved SB 973 by Sen. Mary Cavanagh (D-Redford Twp.), which deals with private insurers, and SB 974 by Sen. Jeff Irwin (D-Ann Arbor), which deals with Medicaid. The bill deals with contraceptives that have been approved by the federal government for over-the-counter purchases not requiring a prescription. But if a birth control method does not have approval to be distributed without a prescription from a health care professional, the bills do not apply.
According to GoodRX, the prescription drug price tracker, pharmacist-prescribed birth control in Michigan is allowed solely through pharmacist-physician partnerships.
In March of this year, the country’s first over-the-counter birth control pill, Opill, became available for purchase in stores like CVS, Walgreens and Walmart. While Opill, an oral contraception, can be purchased without a prescription, health insurers are still generally able to require prescriptions ahead of providing coverage.
If the U.S. Food and Drug Administration approves future hormonal drugs and devices for over-the-counter availability, insurers are still permitted under the legislation to subject them to prior authorization and quantity limit restrictions.
But overall, an insurer must deliver coverage for an over-the-counter contraceptive without needing a prescription.
Sens. Thomas Albert (R-Lowell), Joseph Bellino JR. (R-Monroe), Kevin Daley (R-Lum), John Damoose (R-Harbor Springs), Jonathan Lindsey (R-Brooklyn), Ed McBroom (R-Waucedah Twp.), Rick Outman (R-Six Lakes), Jim Runestad (R-White Lake) and Lana Theis (R-Brighton) opposed the bills.
Albert offered an unsuccessful proposal to ban insurers from covering puberty blockers, cross-sex hormones and genital and nongenital reassignment surgeries for minors.
He said the bills compel taxpayers to fund contraceptives despite “deeply held and religious beliefs they may hold.” He called the legislation a “patent violation” of the federal Religious Freedom Restoration Act of 1993.
In 2014, the U.S. Supreme Court ruled 5-4 in favor that, through the Religious Freedom Restoration Act, the Hobby Lobby retail company was able to opt-out of the Affordable Care Act’s contraceptive mandate because of the business’ religious beliefs. The ruling was limited to healthcare plans offered by “closely held companies,” however, where there is a small number of owners unlike large-scale public companies.
“In these bills, we see no accommodation going forward, making these bills glaringly unconstitutional,” Albert said. “And just to be clear, one would be wrong to think that Michigan would get a pass because the Religious Freedom Restoration Act is federal law. It clearly applies to both the federal government, as well as individual states.”
He suggested the bills will put taxpayers’ on the hook for attorney fees and awards.
On the other hand, there are states where pharmacists themselves can prescribe birth control without physician partnerships, and regardless of the customer’s age. They include California, Hawaii, Idaho, Illinois, New Mexico, Oregon and Vermont.
Still waiting on Senate approval, after passing in the House 56-53 in November, is HB 5436 , which authorizes pharmacists in Michigan to prescribe and dispense birth control regardless of the purchaser’s age.
Centralized Health Information System Sent To House
A statewide computer system designed to give doctors access to a patient’s complete health care record would be created under legislation that moved out of the House Health Policy Committee on early this month.
HB 5283 and HB 5284 allow the state to contract with a non-profit entity to create a standardized system that providers could use to input data on the patients they see into an enormous database that could only be accessed by other health care providers.
The Health Information Exchange is envisioned as creating better coordination among providers to help them provide the best care possible for a patient at a moment’s notice.
“By delivering the right information for the right patient at the right time, together, we can even save lives,” said Isabell Pacheco, chief administrative officer at the Michigan Health Information Network, during a June committee hearing on the subject.
An H-11 substitute version of HB 5284 was supported by Republicans and Democrats on the committee as the bills were sponsored by committee chair, Rep. Julie Rogers (D-Kalamazoo) and the committee’s minority vice chair, Rep. Curtis VanderWall (R-Ludington).
“Health related social needs are seen everywhere, but they happen in silos. They’re seen everywhere and shared nowhere,” said Janee Tyus, senior program director of Greater Flint Health Coalition.
The committee also moved out:
– HB 5178 , which protects participants, employers and volunteers in syringe service programs from being criminally prosecuted for drug paraphernalia charges.
– HB 5636 , which requires birthing centers to have a state license so they will be eligible for Medicaid reimbursement funding.
– SB 668 , which would allow people to go through physical therapy without a provider referral and removes the length of time that a physical therapist has to rehabilitate a patient who does not have a referral.
– HB 5938 requires insurers to reimburse dentists with something other than a virtual credit card (VCC), which charges 2% to 5% in fees on dentists.
East Lansing dentist Vince Bnivegna said direct bank transfers, checks and electronic fund transfers don’t bring the same type of “burdensome transaction fees” that come with VVcs.
“These fees quickly add up over a few months and 1,000 procedures,” he said. “There is also an administrative burden on our staff.”
The Michigan Dental Association was neutral on the bill and the Michigan Association of Health Plans was in support. The bill was reported with Democratic committee members in support and Republicans abstaining.
– HB 4833 , which removes the licensure requirement for entities that only provide substance abuse disorder prevention treatment services. The bill was supported by the Department of Licensing and Regulatory Affairs because it will erase the need for entities to obtain duplicative licenses.
– HB 5616 allows eye doctors to send medications home with their patients as opposed to needing to throw them away after the patient has been discharged. In a June committee hearing, eye doctors said the medications they prescribe are expensive, and it makes no sense to waste medicines if it’s going to be used by the same person over and over again.
– HB 5371 and HB 5372 allows certified community behavioral health clinics to continue to receive Medicaid and Medicare for their services after a specific pilot program expires on Oct. 1, 2027.
These clinics provide 24/7 crisis management, primary care screening and care coordination with people with mental health and substance abuse issues.
The committee took testimony on:
– HB 5964 , which eliminates the sunset on Michigan’s participation in the Interstate Medical Licensure Compact, which allows doctors who are licensed in other compact states the ability to seek licensure quickly in Michigan.
Dr. Muhammad Salameh, chief medical officer of Trinity Health Medical Group, testified that the bill would allow his group to use one process to license its physicians.
The bill was supported by Blue Cross Blue Shield, Henry Ford Hospital, the Michigan Health and Hospital Association, AARP of Michigan and the Michigan Association of Health Plans.
Senate Huffs, Huffs & Passes Fines And Fees For Cigarette, Vape Retailers; More Chamber News
Stores will pay a $500 yearly licensing fee if they’re selling vapes and cigarettes, under a new “Nicotine and Tobacco Act” the Senate passed by a party-line vote this month. The bills also raise the penalties for retailers that fail to examine IDs and sell to minors.
The bills – SB 651 , SB 652 , SB 653 and SB 654 – reform how the state restricts vapes and cigarettes from being obtained by youths. Currently in Michigan, minors attempting to purchase vapor products or using one in a public place can face a $50 civil infraction and be ordered to perform up to 16 hours of community service.
Instead, under the four bills, the penalties on minors are eliminated, and instead, retailers will receive a detailed list of heightened punishments. For example, if they fail to examine a photo ID when selling a vape or cigarette three times within three years, they could face a $3,000 fine and seven-day license suspension.
“Creating a tobacco retail license will be instrumental to reducing illegal sales of tobacco and nicotine. It’s time to protect our kids and hold retailers accountable for leading youth into a lifetime of addiction,” said Jodi Radke, the co-chair of the Keep MI Kids Tobacco Free Alliance.
In an Oct. 30 letter to the Senate Regulatory Affairs Committee, Radke and pediatrician Dr. Brittany Tayler, the other co-chair, wrote that middle and high school students in the state were accessing tobacco products “more kid-friendly than ever.”
“Thousands of products like cotton candy and bubble gum e-cigarettes can deliver massive doses of nicotine. The time is now for Michigan lawmakers to stand up for Michigan kids,” the letter reads, adding that the bills require “tobacco retailers to be licensed, just like liquor retailers, so the state can enforce laws prohibiting the sale of tobacco to minors.”
The bills passed with all Republicans opposed.
HIV Preventative Medication Would Be Covered Under Bill
The House Insurance and Financial Services Committee heard testimony this month on the importance of a bill that would require insurance plans to cover HIV medication.
Rep. Mike McFall (D-Hazel Park) said his HB 5340 would codify the Affordable Care Act’s preventative care requirement for pre-exposure prophylaxis (PrEP) without cost sharing.
“There have been legal challenges to the ACA since its adoption,” McFall told the committee. “… With my bill, the federal ACA and its preventative care protections will be enshrined in Michigan law . . .
“This means that Michiganders no longer have to live in fear that their life-saving medication could be stripped away from them overnight by a federal court across the country,” he added.
Braidwood Managements v. Becerra deals specifically with PrEP, an FDA-approved medication that helps reduce the spread of HIV by up to 99%, according to.
Anthony Williams, president and CEO of Corktown Health, testified in support of the bill, calling it a “vital step in combating the HIV epidemic.” Dr. Paul Benson said PrEP should be treated like any other medication, such as those that treat cancers, because there is no difference between them.
“The impact of this legislation extends beyond the individual health outcomes,” Williams said. “It represents sound public policy. For every new HIV infection prevented, the state saves approximately $400,000.”