Isaac Bashevis Singer is famous for, among other things, his collection of Yiddish folk tales about The Wise Men of Chelm, a town in Poland which, according to the folk tales, was populated entirely by fools.

One of the stories about the people of Chelm was about a playground located near the top of a cliff. Every once in awhile, a child would fall off the cliff and injure themselves on the ground below.

The Wise Men of Chelm came up with an ingenious solution to the problem: They built a hospital at the bottom of the cliff. That way, the children could be rushed into the emergency room quickly for medical treatment.

I was reminded of this story when reading the following AP article posted moments ago:

LANSING, Mich. (AP) — Michigan Gov. Rick Snyder will propose $30 million in state funding...

(thanks to Hector Solon for the tip)

OK, as far as crimes and/or stupidity by the Michigan GOP goes, this is pretty small potatoes these days. Even so...

So, you may have heard that the Republican-controlled Michigan state legislature recently passed (and Governor Rick "Leadfoot" Snyder signed) a dead-of-night bill which, for absolutely no reason whatsoever...

...bans any public body or public official, except for “an election official in the performance of his or her duties,” from using public funds to issue any kind of communication that “references a local ballot question, and is targeted to the relevant electorate where the local ballot question appears on the ballot,” in the 60-day run-up to an election.

UPDATE: I thought this was obvious, but apparently not: I'm not saying that a complete relocation of the entire population of Flint will be necessary, I'm just trying to get some sort of feel for how much it would theoretically cost if they had to be relocated.

For example, Wired Magazine has posted a more detailed analysis of the actual cost/mechanics/logistics involved in ripping out and replacing the entire city's piping system. The good news? The estimate of just replacing the pipes comes in at "only" $60 million, vs. the $1.5 billion I've seen thrown around. The bad news?

"A September estimate, only recently released by Michigan governor Rick Snyder, puts the cost of replacing all the lead pipes in Flint at $60 million. And the project will take 15 years.

Presented without comment, because what the f*ck else am I supposed to add here?

LANSING -- In January of 2015, when state officials were telling worried Flint residents their water was safe to drink, they also were arranging for coolers of purified water in Flint's State Office Building so employees wouldn't have to drink from the taps, according to state government e-mails released Thursday by the liberal group Progress Michigan.

A Jan. 7, 2015, notice from the state Department of Technology, Management and Budget, which oversees state office buildings,references a notice about a violation of drinking water standards that had recently been sent out by the City of Flint.

...State officials could not immediately answer e-mailed questions about the water purchases, including how long the state continued to buy bottled water for state employees in Flint while telling Flint residents the water was safe to drink. An official said the administration was "looking into these issues."

A few minutes ago I noted that Michigan Governor Rick Snyder, currently in the hot seat for poisoning nearly 100,000 of his residents, has formally requested full Medicaid coverage for every Flint resident under the age of 21 (around 30,000 people, as far as I can tell). While my post was sarcastic, the need is real, and while it's revolting that Snyder would try to get the federal government to literally pay for his administration's crime, the move itself makes sense.

Here's a related development which makes sense as well (thanks to Rachel Karas for the link): A letter from U.S. Senator Gary Peters and U.S. Rep. Dan Kildee to HHS Secretary Sylvia Burwell (emphasis added):

January 22, 2016

Dear Secretary Burwell:

Boy, all that fuss and arguing over the best path towards universal healthcare seems awfully silly this morning.

The Detroit Free Press, Tuesday evening:

Snyder to seek aid for Flint children exposed to lead

Michigan governor seeks to expand Medicaid to help at-risk young people exposed to lead in Flint during water crisis

Gov. Rick Snyder said Tuesday he will seek permission from the Obama administration to allow all young people in Flint the chance to receive publicly funded health care services for lead exposure amid the city's contaminated drinking water crisis.

...The White House and federal Department of Health and Human Services did not have an immediate response Tuesday to Snyder's initiative targeting Flint residents up to age 21 through the expansion of Medicaid.


Some readers may wonder why I, a lifelong Michigan resident who authors a website devoted to healthcare issues, haven't posted anything about my home state's latest shame, the Flint Water Poisoning scandal.

The answer is pretty simple: What the hell else is there for me to add? Our governor, Rick Snyder, along with a bunch of people at the top levels of his administration, who he appointed, appear to be guilty of, at best, criminal negligence (and at worst, potential negligent manslaughter) of the 100,000 citizens of Flint, Michigan...all in order to "save money". In fact, they were so intent on "saving money" that they didn't even bother to spend the $100 per day that it apparently would have cost to prevent hundreds or potentially thousands of children from suffering permanent physiological and mental damage.

Well, this is mostly good news, anyway. A week or so I reported that Michigan's version of the ACA's Medicaid expansion provision (called simply "Healthy Michigan") was at risk of having the plug pulled because a) it has to be re-approved by CMS and b) the revised version of the waiver includes some pretty draconian extra requirements.

The problem was that if CMS didn't approve the waiver, the entire program would be shut down, kicking some 600,000 Michiganders off their healthcare coverage next April.

Well, as Amy Lynn Smith reports via Eclectablog, CMS did end up approving the waiver after all, ensuring that the Healthy Michigan program continues for another few years:

CMS has approved the second waiver and the Healthy Michigan Plan will continue without any disruption.

Michigan Governor Rick Snyder had this to say in a statement:

Unlike the exchange QHP enrollments, which will always continue to be the heart and soul of this website (it's right there in the name, after all), I've kind of gotten away from trying to track Medicaid expansion on a granular level over the past few months. The main reason for this is that in many of the expansion states, they've simply maxed out on enrollees, and the numbers from week to week or even month to month are simply holding steady at this point.

This is the first post I've written since Friday, partly because I had my kid's Lego® Robotics League event all day Saturday, partly because I came down with a 24-hour (I hope) flu yesterday.

Anyway, some not-so-cheery news to report today:

MICHIGAN WAIVER PUTS CMS IN TOUGH SPOT — The federal waiver Michigan needs to extend its Medicaid expansion has put CMS in a bind — either approve controversial conditions or let the program end next spring. Pro’s Rachana Pradhan writes, “The 2013 Michigan law expanding Medicaid included a provision requiring CMS to approve a waiver with drastically conservative changes by the end of this year. The waiver would require Medicaid enrollees earning above the poverty line to make a choice after four years of Medicaid coverage: Either enroll in a private subsidized plan on HealthCare.gov, or stay in Medicaid and pay up to 7 percent of household income toward health care costs — notably higher than the 5 percent ceiling CMS has held other states to.” If the waiver isn't approved, Medicaid expansion coverage is scheduled to end in April.

Since today's just filled with wonderful news for 418,000 Kentucky residents who are very likely to lose Medicaid coverage, I figured I might as well toss this on the fire as well:

It appears that East Lansing-based Consumers Mutual Insurance of Michigan could wind down operations this year as it is not participating in the state health insurance exchange for 2016.

But officials of Consumers Mutual today are discussing several options that could determine its future status with the state Department of Insurance and Financial Services, said David Eich, marketing and public relations officer with Consumers Mutual.

Consumers Mutual CEO Dennis Litos said: "We are reviewing our situation (financial condition) with DIFS and should conclude on a future direction this week.”

Well I'll be damned. Given all the tea leaf/entrail-reading that I've had to do in some states to try and piece together the weighted average rate increases for 2016 (usually due to missing enrollment/market share data for the companies participating), it's a pleasant surprise to see that my own state of Michigan has posted the approved rate hikes without any gobbledygook:

Individual market to increase on average 6.5%, small group 1.0%


LANSING - Michigan consumers and small businesses will experience lower increases in the cost of their 2016 health insurance plan than those in many other states, according to the Michigan Department of Insurance and Financial Services (DIFS). DIFS reports that the average approved rate changes on a premium weighted basis increased by 6.5 percent for the individual market and 1 percent for the small group market.

Nice job by Amy Lynn Smith over at Eclectablog today:

Once again, the Affordable Care Act (ACA) is proving its critics wrong. Opponents of the ACA, or Obamacare, have been falling all over themselves proclaiming that an influx of new patients will overburden the healthcare system, creating a dire doctor shortage.

At least in Michigan, that’s proven to be absolutely false.

A new University of Michigan study shows that the availability of primary care appointments actually improved for people with Medicaid in the first months after the state launched the Healthy Michigan Plan, the state’s Medicaid expansion under the ACA. What’s more, it remained mostly unchanged for those with private insurance.

This AP article provides snippets about a handful of states; it'd be nice if they just released the actual report so we could see the hard expansion numbers (as opposed to the total increase numbers, which are still obviously useful but don't distinguish between traditional Medicaid and ACA expansion enrollees):

In Kentucky, for example, enrollments during the 2014 fiscal year were more than double the number projected, with almost 311,000 newly eligible residents signing up. That's greater than what was initially predicted through 2021. 

...At least 14 states have seen new enrollments exceed their original projections, causing at least seven to increase their cost estimates for 2017, according to an Associated Press analysis of state budget projections, Medicaid enrollments and cost details in the expansion states. A few states said they could not provide original projections.

As I noted at the end of April, after climbing at a furious pace every week for months on end, Michigan's implementation of the Affordable Care Act's Medicaid expansion provision (aka "Healthy Michigan") plateaued at around 600,000 enrollees back in February, and then bobbled around the 600K level for several weeks straight. As I noted at the time, I'm still checking this figure weekly, but it has never deviated far from that number--sometimes a bit higher, sometimes lower.

As of June 30th, it stood at 606,779. 600K seems to be the level that ACA Medicaid expansion can be expected to stay at for the forseeable future.