The Obamacare Exchange in Michigan

Background:

The Obamacare Exchange Bill passed the MI Senate November 10, 2011 by an expedited procedure. Suspending the rules of the chamber, which required at least three days for final text review before a floor vote, the Senate sent SB 693 through committee vote, floor vote, and over to the House Health Committee all on the same day, with no opportunity for public comment on the record. (Journal of the Senate, pp 4-6.) A Facebook conversation with my Senator, right up to the time he went to vote, was less than effective. As closely as I can recall, his words were, “You don’t understand, Obamacare is the law of the land, at least this will put the state in control of Obamacare instead of the Federal government.” No amount of evidence that state implementation of PPACA Exchanges was optional, that it unnecessarily entrenched bad law, and that the nature of federal programs was federal control, could alter his determination to vote for passage of the bill.

 After the ensuing public outcry, the MI House proposed a more transparent path. Individuals and organizations from all over the state prepared to attend the House Health Policy Committee Hearing on the bill. The day of the hearing, January 19, 2012, dawned with Michigan under 6-12″ of fresh snowfall and shrouded in blizzard. Regardless of how many were kept home by the weather, 9:30 am saw the large committee room packed to the exits, all seats full and the back of the room several rows deep in standing guests. Ushers in their red coats kept order and at last brought the pile of testimony cards forward to the clerk, my own among the others. Chairing the hearing at the head of the committee dais was Representative Gail Haines (District 43, Oakland County).

I attended with friends from West Michigan, and was invited to testify as a member of Docs4PatientCare, a physicians’ group formed to oppose state roll-out of Obamacare. One by one over the next several hours, the names on the cards were read into the record: supporting the bill, opposing the bill, testifying, not testifying. One by one, individuals and organizations from all over the state sat at the witness table and spoke into the microphone. Occasional applause  at particularly passionate or well-argued opposition to the bill was rapidly quelled by the chair. Finally, she announced the final name from the stack of cards. It wasn’t mine. For a moment, I stared unbelievingly at the clerk. Quickly completing another card and surreptitiously touching the sleeve of an usher beyond the railing, I asked him to bring it to the chair’s attention. Thankfully, he did.

This is my testimony.

Madam Chair, Members of the Committee, and guests. My name is Abigail Nobel. I am a Bachelor’s-prepared nurse of 23 years, Board-Certified in Ambulatory Care Nursing.

I have been passionate about nursing since I was 3 years old, but I will be the first to grant that my profession faces major problems. My goal is to stop Obamacare until it can be repealed. Even when that is done, we will still be left with major problems in healthcare. It just so happens most of them are caused by poor government policy. Let me give some examples from my experiences in various areas of care.

As a Nurse’s Aide working my way through college, I had to haul ninety-year-old nursing home residents out of bed at 6 AM, because regulations dictated how many hours were allowed between supper and breakfast. No excuses for these elderly survivors of life!  This was the first time I felt the gut-wrenching impasse of being forced to choose between obeying the law and giving good patient care. Unfortunately, it would not be the last.

As a nursing student, I learned that OB providers had the highest malpractice insurance, not because they were bad doctors, but because when it came to babies with problems, juries would award any amount.

In surgery, well-established protocols were scrapped in favor of nationwide “best practice” standards, putting Michigan patients at risk because a surgeon in Florida amputated the wrong body part.

In postoperative care, I learned that patients’ vital signs were routinely over-monitored –a nurse might take extra vitals, but woe to one who skipped any, no matter how stable the patient or how sore their arm from the BP cuff!

On medical units, regulations mandated I stay at the side of a comfortable patient instead of going to ones who needed me–simply because the standard number of minutes had not passed since administering a medication the patient and I both knew was safe for her.

I left homecare soon after the day it took eight hours of stultifying paperwork to document one hour of patient care.

Not all of healthcare’s micromanagement comes from insurance and government. Some comes from hospitals themselves as they give a whole new meaning to “preventive medicine“. Healthcare law is so complex, and the threat of lawsuits so frightful, that many hire full-time lawyers to guide their policy. This is in addition to industry lobbyists who jockey for legislative advantage to improve their market share.

Throughout my nursing career, I have noticed that patients who paid the least for their care were often the most resistant to education about lifestyle change, the key to up to *90% of hospital admissions.

In short, top-down organization and government regulation of healthcare have been tried and failed abysmally either to control costs or to improve patient health. Furthermore, these ever-tightening controls have served to actually increase costs due to heavier documentation and staffing requirements of the over-regulation. But it’s not like there are not better options for legislative action! In my lifetime healthcare has never enjoyed a free market environment. It is well past time to turn to genuine free market solutions.

Please, be clear about Michigan’s policy going forward:

• Insurance is not care; and healthcare is a service, not a right.
• Repeal existing regulations such as Certificate of Need and BCBS/Priority Health monopoly protections which stand in the way of innovation and entrepreneurship in the real healthcare marketplace, which is found in our yellow pages across Michigan.
• Reduce reliance on 3^rd party payers by promoting direct pay, HSAs, and a culture of patient independence rather than reliance upon insurance or government programs.
• Reverse the trend to single payer.
• Michigan previously passed legislation to reduce the cost of malpractice litigation. Please revisit this area and consider further reforms in all areas I’ve mentioned. More information is available at heartland.org and other resources like Cato Institute.

Finally, please draw the line for special interest groups. We Americans have a long, proud tradition of helping our neighbors in person and through charitable organizations both secular and religious. Let us assume our proper role of love and accountability. It is not one for which government of any level is suited.

Thank you.

* The data available in 2014 indicates a number closer to 80%. Sources available upon request.

Afterward

Testimony given that day, combined with opposing letters, petitions, phone calls, emails, and social media messages from thousands of constituents led the Michigan House to let SB 693 rest in committee until the end of the 2011-12 term, effectively killing the Michigan State Exchange.

The following session, the Partnership Exchange was a sort of half-way measure that advanced through the legislature by a reversed course. Greased by $30,670,000 from HHS, it slipped through the House on February 28, 2013, tucked into spending bill HB 4111. Opponents  hardly dared hope to stop it in the Senate, but again, citizens actively protested and the bill died without a floor vote.

Medicaid Expansion was the third and final major component of Obamacare which depended upon state cooperation to become effective law. Telling the story of how it became Michigan law will take another blog post, but for purposes of this post, it remains the only part of Obamacare “owned” by the people and officials of the state of Michigan.

The consequences of locking Obamacare Exchanges out of Michigan law are numerous, and multiplying.

• Michigan businesses are free from the Obamacare penalties that come with the State Exchanges.
• Michigan taxpayers are free from the state-level financial burden of building and maintaining the State Exchanges.
• As Obamacare’s high deductibles, high premiums, and denials of care become more apparent, more people are realizing that the free market has been the better alternative all along. In overcoming the natural human dislike for change, not having a State Exchange means Michigan residents will have one less barrier to jettisoning Obamacare. They will not face the oddly personal attachment that often comes with state health programs like Britain’s NHS, despite all quality evidence to the contrary.
• Obamacare enrollment puts people off for several reasons. Besides the initial sign-up problems at healthcare.gov, the premium prices are very high — too high for most people unless their plans are subsidized. If the Supreme Court decides for the letter of the law in King v. Burwell, the Federal Exchange will lose all subsidies. That means that all Obamacare enrollees residing in states without a State Exchange, like Michigan, will face full prices on their plans. Barring another administrative rule change or Congressional legislative fix, many Obamacare enrollees would abandon the Federal Exchange and look elsewhere for affordable care. Loss of enrollment numbers are the kiss of death for this new federal program, rendering it unsustainable both politically and actuarially. (Yes, there’s a name for the science of insuring people!)

It is not too much to say that stopping the Obamacare State Exchange in Michigan may have been the beginning of the end for Obamacare itself.