Michigan

On November 8, 2010--right after the "Red Wave" midterm election in which Republicans picked up a jaw-dropping 63 seats in the U.S. House of Representatives, 6 Senate seats and 680 state legislative seats--Paul Waldman wrote, in The American Prospect:

In charting the last two years, from the euphoria of election night 2008 to the despair of election night 2010, I keep returning to Mario Cuomo's famous dictum that you campaign in poetry but govern in prose. The poetry of campaigning is lofty, gauzy, full of possibility, a world where problems are solved just because we want them to be and opposition melts away before us. The prose of governing is messy and maddening, full of compromises and half-victories that leave a sour taste in one's mouth.

...All else being equal, this means Republicans have an easier time getting elected and a harder time legislating the things they really want to do (other than tax cuts, which are never a hard sell), while Democrats have a harder time getting elected but ought to have an easier time legislating.

Welp. There you have it. Via Jonathan Oosting of the Detroit News:

Snyder signs 80-hour Medicaid work requirement law

Most adult Medicaid recipients who receive health care insurance through the state’s Healthy Michigan plan will be required to work at least 80 hours per month or risk losing coverage under a new law signed Friday by Republican Gov. Rick Snyder.

Five years after he led the push to expand Medicaid eligibility under the federal Affordable Care Act, Snyder signed the new work requirements over protests from Democrats and advocacy groups who decried it as a legislative effort to strip health insurance from low-income residents.

...“The original estimates were that 400,000 people without health care would be able to obtain it after the creation of Healthy Michigan, and today more than 670,000 people have coverage. I am committed to ensuring the program stays in place and that Michiganders continue to live healthier lives because of it.”

NOTE: I originally missed two carriers (McLaren and Molina); thanks to Louise Norris for calling attention to my error. The entire post, along with the table, has been updated to reflect the updated numbers including all 11 carriers.

Also note that while the headline originally reflected what the average rate change would be without the CSR load sabotage factor introduced in 2017, I've decided to be consistent with other states and only include 2018 sabotage impact.

My home state of Michigan just posted their preliminary requested rate changes for the 2019 Open Enrollment Period, and unlike most of the other states which have released their early requests so far, Michigan is a pleasant surprise: An overall average requested premium increase of just 1.7%!

Also noteworthy: According to the filings, eight of the carriers are specifically projecting exactly a 5% mandate repeal factor, which is remarkably consistent (usually the projections are all over the place). HAP is slightly lower (4.4%) while Molina is higher (7.2%). Priority Health didn't mention this at all, but it's safe to assume it'd be roughly 5% for them as well.

NOTE: The original post was getting to long/unwieldy so I've separated out my initial analysis of the proposal into this separate post.

Yesterday, Michigan Democratic Gubernatorial candidate Abdul El-Sayed publicly rolled out his vision for a state-based Single Payer healthcare system. I wrote up an overview yesterday. Below are my initial thoughts, based on reading both the summary and full version of the proposal as presented on El-Sayed's website.

UPDATE 4:30pm: (sigh) As I expected, the stripped-down version of SB897 passed the state House

SB 897, to impose Medicaid work requirements, passed the House 62-47. #mileg

— Lindsay VanHulle (@LindsayVanHulle) June 6, 2018

The revised version of the bill still has to be kicked back over to the state Senate for a final vote, but that's almost certain to pass, so the only thing stopping it at this point is the possibility of Gov. Rick Snyder vetoing it, which is what I figured it would come down to in the the first place.

UPDATE 6/11/18: So much for that prospect:

UPDATE: OK, it looks like El-Sayed's campaign has already released his plan details after all. I'm reading it over now and will update with my thoughts later today.

UPDATE Midnight Wednesday: Scroll down for my initial thoughts (more tomorrow)

Later today, Michigan Democratic gubernatorial candidate Abdul El-Sayed is expected to release his plan for a state-level single payer healthcare system for my home state of Michigan:

A Democrat running for governor in Michigan is supporting a tax increase to pay for a statewide government-run health-care system, going further than his party’s candidates in other parts of the country who are also calling for expanded coverage.

Sadly, this is pretty much exactly what I've been expecting:

Sen. Mike SHIRKEY (R-ClarkLake) said today he's hammered out an agreement with the administration and the House on creating work requirements for Medicaid recipients.

Speaking during a taping of "Off The Record," Shirkey said, "We have a deal." All sides have signed off on the exemptions to the work requirement, but he didn't get into all fo them pending a formal announcement coming as soon as later this week.

From the wording of this, it sounds an awful lot like "all sides" appears to refer to Republican Senator Shirkey, the rest of the Republican State Senate, the Republican State House and the Republican Governor.

Shirkey confirmed that the 29-hour job requirement in the Senate bill has been pared back to 20 to which he says, "I was hoping Michigan could take a leadership position and set a new standard for that." But rather than jeopardize the entire package, he compromised.

*(To be honest, all of these types of bills--work requirements for Medicaid, drug testing for welfare benefits, photo ID for voting--have at least a tinge of racism to them no matter what, but at least this one isn't blatantly racist anymore).

This just in off the AP newswire...

LANSING, Mich. (AP) — The sponsor of proposed Medicaid work requirements said Monday that lawmakers are removing a provision to exempt recipients who live in Michigan counties with high unemployment, saying it would have been too difficult to administer and denying allegations of racism.

Republican Sen. Mike Shirkey of Clarklake also told The Associated Press that the proposed 29-hour-a week workforce engagement requirement for able-bodied adults is being lowered to “very close” to 20 weeks. That is in line with the three states that have enacted Medicaid work laws and with Michigan’s work requirement for food assistance beneficiaries.

A week or so ago, I noted that Republicans in my home state of Michigan have come up with a clever way of having their (chocolate) cake and eating the (vanilla) cake too. As first noted by Nancy Kaffer of the Detroit Free Press:

Although HB 897 threatens to end Medicaid benefits for hundreds of thousands living elsewhere in the state, it includes exemptions for people who live in counties with an unemployment rate of more than 8.5%, like the ones Schmidt represents.

Live in Detroit? You're out of luck.

The city's unemployment rate is higher than 8.5%, but the unemployment rate in surrounding Wayne County is just 5.5% — meaning Detroiters living in poverty, with a dysfunctional transit system that makes it harder to reach good-paying jobs, won't qualify for that exemption. The same is true in Flint and the state's other struggling cities.

...which brings me to today's Detroit News, via Jonathan Oosting:

Senate uses salary threat to push Medicaid work plan

Lansing — Michigan’s Republican-led Senate is pressuring Gov. Rick Snyder to back sweeping changes to the state’s Medicaid health insurance system, including proposed work requirements and a tougher 48-month benefit limit for the Healthy Michigan plan.

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