Universal Means for Everyone

1
Universal Means for Everyone!

• Its the promise of this grant.
• Michicare?
• Better for people better for business

2
Coverage

• Everybody in!
• Phase in uninsured first.
• No means test
• Insurance not related to employment
• All are automatically in the plan
• Present HMOs Blue Cross HAP and selected
  others to bid on covering the uninsured and on
  everyone within 5 years.

3
Summary

• Early phases focus on primary and preventive
  care.
• Multiple payers but substantially fewer than at
  present.
• State to collect funds and contract with health
  insurance carriers as we do in Medicaid.
• Capitation rate to insurers in either case.

4
Funding Summary

• Integrate workers disability WC, motor vehicle
  medical coverage PIP, and other medical
  coverage to lessen administrative and claims
  overhead.
• Legislate that there can be no exclusions for WC,
  PIP or other categorical coverage one
  policy/one person.
• Assess a fee to motor vehicle owners,
  individuals, and employers at a rate lower than
  present WC, PIP, administrative costs and capture
  funds for coverage.

5
Timeline Year One and Two

• Year One make changes to WC PIP etc and begin
  collecting funds.
• Give DCH authority over all medical programs and
  discretion over use of funds.
• Use funds to cover the uninsured in year one or
  two, as funds needed are collected.
• Begin debate over a fair financing system needed
  to make system permanent, universal, and
  comprehensive

6
Time Line Year Two and Three

• Cover everyone!
• Assess and implement benefits based on
  finances
• Focus on chronic diseases
• State to establish price limits for procedures
  and care such as WCs cost containment
• Age tiering people on Medicare would need
  less coverage from Michicare.
• Establish savings based on quality measures
  and mechanism to collect portion of savings

7
Time Line Year Four and Five

• Assure comprehensive benefits as in Michicare
  legislation.
• Implement general fair financing mechanism to
  take the burden of health insurance off of
  employers.
• System unique to Michigan would draw business to
  the state.

8
Benefit Package

• Phase One Collecting funds and programs under
  DCH.
• Phase Two Covering the Uninsured Medicaid
  benefit package.
• Phase Three Covering All depending on funds
  comprehensive benefit package. Take burden off of
  employers!

9
Quality of Care/Effect on Delivery System

• Use incentives to promote evidence-based medicine
  
• Use pay-for-performance model to save on quality
• Use disease-based protocols
• Use incentives to patients to promote healthy
  behavior
• Use incentives to providers to promote the use of
  electronic records, or simply require this
• Use incentive plans for geographic access

10
Quality Control

• Establish mechanism to measure savings because of
  quality control
• Establish savings goals (savings in Maine were
  43 million in a system 1/10th the size of
  Michigan)

11
Cost Considerations

• Anticipate greater cost when uninsured first get
  covered with lessening thereafter.
• Cost containment by negotiating of pharmaceutical
  prices evidence based medicine e-record
  keeping disease based protocols
• Decreasing number of insurers decreases overhead
• Ending WC, PIP and other medical coverage lessens
  claims systems and disputes.

12
Capturing the Money - Example

• PIP and Catastrophic Claims premiums to go to
  DCH.
• As costs brought under control drop these rates.
• Eventually end the premium system and create a
  fee per motor vehicle at a rate less than present
  day premiums to go to DCH to provide health
  insurance

13
Medicaid??

• Use funds to expand Medicaid program capturing
  federal match
• Allows expansion of Medicaid through present HMO
  driven system

14
Fairness

• Everyone is covered!!.
• Problems of over-insurance lessened.
• Decreasing administrative cost for all.
• Quick access for uninsured to primary/preventive
  care decreases use of ER in near future.
• Care management and disease based treatment
  lessen costs.

15
Equity

• All have set benefits for medically necessary
  services.
• Allowed to buy policy covering more.
• No coverage issues with claims of categorical
  coverage.
• No loss of health insurance if job is lost.
• Increased regulation, and increased incentives.

16
Consumer Choice

• Consumer given list of insurance companies or
  HMOs to choose from.
• May choose any company.
• Providers not limited.

17
Tradeoffs

• End some programs to increase funds used for
  general health insurance.
• Greater regulation of provider pricing.
• Employers lose control of HI industry.
• Medical malpractice premiums should drop.
• Universal system would draw business into the
  state.

18
Tradeoffs

• Health insurance off the collective bargaining
  table
• Greater regulation of pharmaceutical pricing
  through negotiation
• Note System would not affect technological
  innovation