Co-Location of Health Department and CMH, Health Care Millage, Campaign Update

We had another busy week this week on the County Commission.

Both the County Services and Human Services committees took up the resolution to allow for co-location of the Community Mental Health and Ingham County Health Department. Co-locating a Health Department clinic at the CMH facility will allow mentally ill patients to get the care that they need. These folks do not come to the Health Department for treatment, but are are at CMH. This effort can make a real difference in the lives of these patients. This is a complicated effort because it is moving people around from one clinic to another. CMH will be providing the office space at $45,000 per year. The UAW testified that the contract was violated because this would create a new job without informing the UAW (as specified in the contract) but that this is overall a good idea and that they support it. They requested that this effort be reviewed by the Human Services committee in 6 months. The Michigan Nurses Association president testified that collaboration with positions makes them comfortable. Nurse Practitioners were concerned about having to deal with situations that are out of their expertise, but the collaboration involved makes them more comfortable. I asked a variety of questions. In Human Services, I asked where the money is coming from - if it was coming from the Health Department Health Department budget or from our contingency fund. I was told that the money will be generated immediately by the federal draw down of dollars from the CMH population, and that the revenue will be generated as the expenses incur. The budget is actually conservative. This information was added to the resolution in County Services. The resolution adds two new positions (doctor and nurse practitioner), and moves one position from another clinic to this one. I asked where the employee is coming from. The answer is that they place people according to their skill set and where the greatest need is. And they look at the impact on the clinic where the change is made. They said that they will move employees to minimize the impact, and agreed to a six month review. We passed the resolution unanimously in both committees.

In the Human Services Committee, we again discussed the Ingham Health Plan (IHP) proposal to place a millage on the ballot. The IHP and the Health Department told us that there are 8,000 – 10,000 people without insurance (even presuming Medicaid is expanded as allowed by the Affordable Care Act). Those under 138% of the poverty level will be covered by the Act. Those that that are between 138% - 250% of the poverty level will be able to purchase insurance from the Health Exchange (which is a menu of insurance options) and will be subsidized based on their income. We were told that many will not have enough money to pay for the premiums on the exchange and if they are paying a certain amount out of pocket then they will be able to opt-out according to the law. 51% of the people that are expected to opt-out and are single, and 49% of the opt-outs have families. $31,000 is the median income (250% of poverty median). Additionally, undocumented and legal immigrants living here are ineligble and go to emergency room. All of these populations will increase taxpayer costs for uncompensated care. For those up to 150% of poverty, 84% of the insurance is covered as subsidies on the exchange (for premiums only, not out of pocket expenses). For those between 200% – 250%, the exchange subsidizes 73% of the cost. This would mean an average out of pocket expense of $328. The Governor and Legislature may expand Medicaid, but also may refuse the federal dollars as other states have done. With Disproportionate Care Funding (DSH) dropping from the federal government, the Ingham Health Plan will not have the funding to provide care to these individuals that make too much for the Affordable Care Act but don't have insurance and don't make enough to be able to pay for the insurance on the Exchange. The IHP is requesting a millage of .61 mills to be placed on the November ballot. This would mean taxes of $30.50 for a house with value of $100,000 (taxable value of $50,000). Commissioner Tennis pointed out that this will keep people out of the Emergency Room and save taxpayers money and will lower health care costs across the board.

August 28th is deadline for a November millage to be placed on the ballot and the Human Services Committee (then the County Commission) will make the decision at the end of August.

I am undecided on whether to vote for this or not. I asked that this not be voted on at the meeting because whether or not the state takes the expanded Medicaid is important, and that decision is not yet made. I don't want to put this on the ballot now and make it okay for the Governor to refuse this federal money. Back-filling this with a local tax before the Governor decides sends a signal that we will pay for it and he can reject the federal money. Commissioner Vickers said that he understands the need, but doesn't think the people can afford this millage. Commissioner McGrain said that health care will be more affordable for everyone, and we don’t want people to opt-out which will result in us paying for their health care.

Campaign Update: We are now 17 days away from the Democratic Primary. I hope all Lansing and Lansing Township residents will go vote on August 7th. I am getting tremendous response at the doors and in various forums with voters. We have plenty of opportunities to volunteer if you are still interested. We are knocking doors every day, making calls, doing data entry, putting up yard signs, and other important things for the campaign. If you want to volunteer, or want a yard sign, or want to contribute to help pay for the costs associated with the campaign, you can email me at andy.schor@gmail.com or you can go to www.andyschor.com. Thanks to everyone for the tremendous support, and I look forward to election day!