Saturday, June 23, 2012

Health Care Millage, Child & Adolescent Health Centers, Contraception and Preventative Care, County Road Advisory Board, Clerk Data, Campaign Update

This week we had committees and spent many hours talking about many important issues.

In the Human Services Committee, we again discussed the request from the Ingham Health Plan to place a millage on the November ballot for funding access to care for the uninsured in Ingham County.

The IHP, along with the Health Department, gave an extensive presentation. They said we have seen a a decline in Disproportionate Share Hospital (DSH) dollars from the federal government, so our primary funding may be going away. There are 32,000 uninsured in Ingham County. The current enrollment for the IHP is 11,500. In order to enroll more, we need higher reimbursement rates for providers so that we have more providers that will accept IHP. Provider capacity is key to increasing enrollment and reducing wait times. We also need more specialty care. The Ingham Health Plan is requesting that the Commissioners place a millage of 0.61 on the November 6th ballot. If approved by the voters, this would mean a home with $50,000 in taxable value would pay $30.50 per year. It would raise $4 million annually. The proposal would have the millage money maintain enrollment capacity, expand access by increasing reimbursement rates, allow for benefit adjustments, and assist in building greater provider capacity.

In discussion, I indicated that I am not ready to vote for this until we have some answers. The first big question to be answered is what the U.S. Supreme Court does with the Affordable Care Act (referred to as Obama-Care by some). This will play a big role in deciding if there is a need for a millage, and what would it would be used for. The IHP has indicated a need either way. If the Act is struck down, the money would be used to pay for what the federal government would have paid for. If the Act is sustained, the IHP thinks the millage money can be used to get to the 100% goal that Ingham County set many years ago. It could be used for people that make more than the IHP requirements, but still don't have insurance. There are
31,700 total uninsured in Ingham County. I expect that we will be finalizing this at the next Human Services meeting, where we will know the the ruling of the Supreme Court.

We also passed a resolution regarding funding the Child & Adolescent Health Centers. We receive money from the Michigan Department of Community Health (MDCH), which provided a total of $3.375 million over five years. MDCH notified the Health Department’s Community Health Center Network (CHCN) of an increase in funding of approximately 10% (up to $375,000 total or up to $75,000 per year). The new grant allocations for the Child & Adolescent Health Centers are:
• Gardner SWP - $110,000 (currently $100,000)
• Willow - $250,000 (currently $225,000)
• Otto - $195,000 (currently $175,000)
• Sexton - $195,000 (currently $175,000)

The new base allocations will take effect this current fiscal year, 2012, and will be applicable to costs for the remainder of the fiscal year. MDCH plans to continue the new allocations for the remainder of the grant cycle, through FY 2017, upon approval of a revised budget and work plan. MDCH conducted its three year review of the child and adolescent health center programs and strongly encouraged the CHCN to use these additional funds to address issues related to:
• Patient Centered Medical Home recognition
• Quality Assurance activities, including compliance monitoring
• Outreach and Enrollment activities related to Medicaid and other health insurance
• Outreach Activities related to youth retention and engagement

As a result, the CHCN will use these additional funds for the following activities:
• Contract with KMD Consulting for up to $35,000 per year, not to exceed $175,000 over the five year period to assist in coordinating Patient Centered Medical Home activities, assist in the development, tracking and training related to ongoing compliance monitoring, assist in outreach and enrollment activities to ensure youth are enrolled in an insurance plan and to assist in outreach and engagement activities to recruit and retain youth in care.
• Engage in health education and outreach activities at each of its four child and adolescent health centers for $35,000 per year, not to exceed $175,000 over the five year period to be used to fund special part time health advocates who will conduct outreach activities related to youth retention and engagement. In addition, as a condition of these awards, the Ingham CHCN was required to establish a local community advisory committee, which was representative of the community and included a broad range of stakeholders and school staff. Resolution 11-235 approved an agreement with the School Community Health Alliance of Michigan with a cost of up to $25,000 for these services. MDCH is now requiring the CHCN to allocate funds
to establish a local community advisory committee at each of its four Child and Adolescent Health Centers. For this reason, the ICHD proposes to increase this agreement to up to $30,000 per year, not to exceed $150,000.

Finally, we passed a resolution in the Human Services Committee that expresses support for access to preventative health care services, including contraception for all women, and strongly supporting insurance coverage of contraception without co-pays. The resolution made the following arguments. The Patient Protection and Affordable Care Act requires new health insurance plans to cover women's preventive health care services without co-pays or cost-sharing on August 1, 2012. This is the same as other preventative services including immunizations and well-child physician services. The intent of Congress to require health insurance plans to cover preventive services was to encourage and invest in basic health care services to improve health outcomes for all Americans. The Institute of Medicine (IOM) - an independent, nonpartisan medical body - has conducted a scientific review and recommended that contraception be considered a preventive service for women under the Affordable Care Act as family planning services improve health care outcomes and wellness for women and families. Access to family planning is directly linked to declines in maternal and infant mortality rates. Contraception enables women to better prevent unintended pregnancy and plan for pregnancy when they do want to have a child, when women plan their pregnancies, they are more likely to seek prenatal care, improving their own health and the health of their children. In addition to the primary purpose of allowing women to plan and prepare for pregnancy, other health benefits of contraception include reduced risk of endometrial and ovarian cancers, ectopic pregnancy, iron deficiency anemia related to heavy menstruation, osteoporosis, ovarian cysts, and pelvic inflammatory disease. The U.S. Department of Health and Human Services (HHS) accepted the recommendation of the IOM, and will therefore require U.S. Food and Drug Administration (FDA)-approved contraceptive methods to be covered by all new health plans without co-pays or cost-sharing. Co-payments and other cost-sharing are barriers to accessing affordable contraception with consequences reflected in sobering statistics concerning unintended pregnancy, and the U.S. has one of the highest rates of unintended pregnancy among the world's most developed nations and consistently lags behind other developed nations in maternal and infant mortality rankings. The cost of the prescription is a major factor in consistent use of prescription birth control, co-pays for birth control pills typically range between $15 and $80 per month, and for other methods, such as IUDs, copays and other out-of-pocket expenses can reach into the hundreds of dollars. Access to health care services, including contraception, is consistent with current policy, including existing federal and state refusal laws. While twenty-eight states require health insurance plans that cover prescription drugs to cover contraception, Michigan does not. As a result of all of these arguments, the resolution expressed support of the County Board of Commissioners for access to preventive health care services, including contraception, for all women and strongly supported insurance coverage of contraception without co-pays and cost-sharing.

Commissioner Vickers said that unintended pregnancies create problems, and insurance companies should provide prescription coverage for these things, but he said he is against resolutions that do not deal with county business. He also indicated that the Affordable Care Act interesting because he has heard from businesses that it is cheaper not to offer insurance and pay the fine than to provide health insurance. Questions were also asked why it would call for no co-pays, and it was pointed out that other services (well child, immunizations, others) do not have co-pays in order to ensure prevention.

A late substitute was offered that included language saying that the Board of Commissioners supports the constitutionality of religious liberty by providing exemptions for religious-based institutions. There was a discussion about the meaning of religious-based institutions. Commissioner Tennis said he would support exemptions for churches, but religious-based hospital systems. We were told that the Affordable Care Act has language saying that employees of religious institutions don't have to abide by things that they have religious objections to. The language will likely be clarified and re-offered on the Commission floor on Tuesday. This resolution passed the Human Services Committee 4-2.

In County Services, we passed the resolution creating the county road advisory board for the Ingham county department of transportation and roads (as explained two weeks ago). We also had a lengthy discussion about the Lake Lansing North trail property. The County Commission had approved $25,000 for this project a few years ago but, apparently, ended up paying over $200,000 for the new trails property when the Department of Natural Resources did not come through with the money they committed. We are trying to figure out the County ended up on the hook and why the Board was not alerted nor asked to vote on this appropriation.

The County Clerk also gave an update on the deleted data. Software is being restored, and the company recovering the deleted data has been working on it for 2-3 weeks. We do not yet have an estimated time for the data to be restored. Once all the programs are back up and running, much of the data will need to be re-scanned back in and we have hired a Vendor to do this. It is approximately 150,000 records to be re-scanned and imported. The County Clerk, Information Systems, and hired vendors are doing a good job trying to re-create this.

On the campaign trail, things continue to be going well. We are receiving more and more endorsements, and are visiting voters at their doors. With just 44 days left before election day, the Schor for State Representative campaign continues in full swing! If you are interested in volunteering for a few hours, you can send the campaign a message at and we will put your time and/or money to good use!

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