A Michigan Minimum Benefit Plan

1. A Michigan Minimum Benefit Plan A Concept for Health Care Affordability Andy JohnstonDirector of Legislative Affairs Grand Rapids Area Chamber of Commerce

2. Background Rising health care costs a top concern Be proactive: Put “Consensus Principles” in action Task Force meeting monthly since July 2007

3. Focus Areas Finance & payment reform Wellness: Educated & accountable consumers Value, quality & efficiency Institute of Medicine 6 quality aims

4. Guiding Principles State level action first Market-based solutions Individual responsibility No unfunded mandates Everything cannot be fixed at once

5. Goals Practical, doable recommendations No increase to state budget Reduce the number of uninsured Affordable solutions that help reduce overall healthcare costs Prevention & wellness addressed All residents have access to minimum preventive and urgent care services

6. Goals continued Portable coverage that belongs to the patient Level playing fields Both positive & negative incentives Solutions must involve all stakeholders Government should facilitate solutions, not impede them

7. Minimum Benefit PlanApproach Summary Not dependent on federal changes Does not increase the state budget Minimum benefit plan developed Health plans required to make the MBP available to all employers Employers must offer at least the MBP – but not required to pay for it Workers working at least 30 hours/week required to purchase

8. Minimum Benefit PlanApproach Summary continued Workers failing to purchase MBP will be assessed $100/month fee MBP offered to all employees leaving employment Plans can include penalties for unhealthy behavior Providers may extend discounts to self-pay patients

9. Action: State Government Define minimum benefit plan - Similar to County Health Plan plans - Wellness & prevention covered - Behavioral health component included - Discounted prescription drugs - Financial penalties for unhealthy behavior - Financial incentives for healthy behaviors - Target premiums: $150/mo & $350/mo - Guaranteed issue

10. Action: State Gov’t continued Allow providers to discount services without penalties by health plans Eliminate unnecessary reporting and regulatory requirements Allow health plans to reward healthy behaviors & penalize unhealthy ones

11. Action: Employers Offer all employees at least the MBP Set up section 125 plans Employees (30+ hrs/wk) must buy MBP, show proof of other coverage or pay $100/mo assessment Offer at least MBP to terminated employees (in addition to COBRA)

12. Action: Health Plans Offer MBP to all employers - Where there currently is no other option Offer MBP to all terminated employees - Where HP is currently offered

13. Action: Consumers Automatic deductible of $3,000 for emergency services resulting from voluntary unhealthy behaviors Required to purchase at least MBP if working 30+ hours/week - Or $100/mo penalty + lose 50% of any income tax refund Required to purchase MBP to receive unemployment benefits

14. Action: Providers Consider offering self-pay patients same discounts as given to health plans - Especially if patient pays at time of service Primary care physicians encouraged to implement patient-centered medical home concept

15. Closing Comments Something must be done Ideas in this paper can be compatible with ideas being discussed at the federal level Proposed ideas aren’t perfect Ideas don’t address all problems But they do represent good thinking by knowledgeable good people Your support is needed

16. Obstacles to Reform Changing Behaviors Changing Mindsets - 401(k)s

17. Obstacles to Reform