Health Care: What’s Ahead?
With the future of the proposed American Health Care Act (AHCA), the current plan to revise and change the Affordable Care Act, uncertain following Republicans and Democrats voicing concerns about the plan, we are taking a look at the provisions and how they could impact Michigan residents.
The AHCA has been under scrutiny since the Congressional Budget Office (CBO) released its analysis of the plan last week, estimating that under the AHCA, 14 million people would lose coverage next year, with 24 million people losing coverage in 10 years.
The findings of the CBO have resulted in both sides of the aisle calling for changes to the plan.
The concern from many lawmakers, hospital groups and philanthropy is that those who may be affected the most by this current piece of legislation are our most vulnerable populations.
A recent analysis by the Center for Healthcare Research and Transformation (CHRT) indicates Michigan Medicaid and Duals, as well as Individual Market participants will be most likely to be affected by the AHCA.
CHRT released a framework on Friday, March 17, that provides a breakdown of the provisions in AHCA and their impact on Michiganders.
The repeal of cost-sharing subsidies for those earning at 250 percent of poverty or less would affect 165,000 Michigan exchange enrollees who received subsidies through the ACA.
The shift of Medicaid funding from the cost of coverage to a per-capita limit would transfer considerable costs to states over time, as medical inflation and enrollment costs do not take into account any technology or intervention enhancements.
The freeze in Medicaid expansion would likely phase out the Healthy Michigan program over time, which currently serves about 649,000 low-income individuals between the ages of 19 and 64.
What's at stake:
While ACA vs. AHCA garners national attention, in Michigan, perhaps the largest area of concern is in preserving what's working. Governor Rick Snyder has shared his concerns about the current plan and how it would affect our state’s Medicaid expansion. Snyder pushed for Michigan to receive expanded Medicaid funding from the federal government, launching the Healthy Michigan plan in 2014.
The Healthy Michigan plan has demonstrated promising outcomes for Michigan, including:
Decreased emergency department utilization, with 70 percent of enrollees reporting that they were more likely to contact their doctor's office before going to the emergency department, and decreasing the instances of enrollees who reported the emergency department as a regular source of care after enrolling in Healthy Michigan from 16 percent to 1.7 percent.
Increased ability to pay medical bills, with 86 percent of enrollees reporting their ability to pay medical bills has been better since enrolling in the program.
Dramatic reduction in the cost of uncompensated care provided by Michigan hospitals. Comparing data from 2013 and 2015 of a consistent hospital set, uncompensated care costs decreased by nearly 50 percent.
A University of Michigan study shows that Healthy Michigan has resulted in the creation of over 39,000 jobs in 2016, including nearly 22,000 jobs outside of the health care sector, with an increased personal income of nearly $2.2 billion, resulting in around $145 million boost in tax revenue in the state.
“Healthy Michigan has been a success in our state, and so that’s one of the things I tried to communicate to Washington is, when you look at this, make sure you have the facts, and how our program has shown we can really help people and do it in a cost-effective fashion,” Snyder said.
Even if the current AHCA plan doesn’t gain traction on Capitol Hill, there will likely be changes to healthcare through revised legislation.
CMF’s Health Funders Affinity Group has been monitoring the potential changes with Medicaid funding and the Affordable Care Act, identifying them as priority areas in their meeting earlier this year. Last week the group gathered in Okemos to get an updated briefing from the director of Michigan’s Medicaid and discuss opportunities for funders.
“Health funders seem eager to learn the future and impact of Michigan’s changing health care landscape so that they can prepare to address gaps and needs,” Nora Maloy, director of programs, Blue Cross Blue Shield Michigan Foundation and co-chair, CMF Health Funders Affinity Group said. “Clearly, the hope is to ensure Michiganders improve and maintain their health.”
The National Center for Responsive Philanthropy (NCRP) shared an article last week calling for long-term advocacy work for funders to keep health equity and health-related issues, especially in low-income communities, front and center.
“State health infrastructure organizations already have health policy and political expertise, but they and community-based partner organizations need capacity to expand community education, constituent leadership development, systematic base-building, and ties with organizations leading other economic and social justice movements,” Kate Villers, NCRP board member said.
Health advocacy recommendations include:
Support long-term efforts to convene stakeholders to develop strategies, effective messaging and coordination of their work, to ensure they can share their stories of the importance of health care coverage and effects of policies.
Support nonpartisan public education about health issues and promote civic engagement, especially in low-income communities
Connect with the Health Funders Affinity Group
Join CMF at The Community Benefit Provided by Hospitals event in May, where discussion will continue on this issue.The future of the proposed American Health Care Act (AHCA), the current plan to revise and change the Affordable Care Act, is uncertain following Republicans and Democrats voicing concerns about the plan.
Road Map for Michigan Education
The 21st Century Education Commission’s report to Governor Rick Snyder provides a recommended road map and identifies priority areas for the Michigan Department of Education (MDE) and community stakeholders.
Issues highlighted in the report:
At-risk students, those of color, in special education or living in poverty underperform compared to their peers in other states
Black fourth-graders in Michigan have the lowest reading performance in the country
Michigan’s higher-income white students are among the worst performing in the country
While the MDE prepares to submit its Every Student Succeeds Act (ESSA) plan to the U.S. Department of Education in two weeks, aimed at addressing some of these issues, what can we do with the commission’s report?
Last week, CMF and the Office of Foundation Liaison (OFL) hosted a webinar where Public Sector Consultants offered insights and takeaways from the commission’s report and discussed opportunities for Michigan philanthropy.
Michelle Richard, vice president, Public Sector Consultants, said funders can help to catalyze support in our communities for the commission’s recommendations and share the issues highlighted in the report to help them gain urgent attention and traction.
Jeffrey Guilfoyle, vice president, Public Sector Consultants, agreed that there’s a need to keep the report in the spotlight but also shared that there are some areas within the commission’s recommendations funders may want to explore.
“I think there are some recommendations around early childhood specifically that are good places for philanthropy to get engaged,” Guilfoyle said.
Highlights of the recommendations include:
Elevate the education profession: Enhance preparation programs and create multiple career pathways for teachers.
Build capacity to do what works: Support the identification, piloting and evaluation of possible solutions.
Invest in an efficient and effective system of public funding: Students with greater educational needs should receive additional resources to ensure equitable funding.
Increase access to postsecondary education: Universal access to community college for all Michigan students and make four-year degrees more affordable for students who demonstrate merit.
Partner with parents: Embed human services in schools to connect students and their families with the services needed. Evaluate parent support and address gaps in parent engagement.
Enhance accountability: Enhance student achievement measures and improve data reporting.
Ensure access to quality learning environments: Assist low-income communities with funding for school facilities as wealthier districts can finance facilities at a much lower tax rate than low-income districts.
Invest early: Support universal preschool for all four-year-olds, develop and retain a quality early childhood workforce and enhance early learning outcome measurement and tracking.
Update K-12 governance: Enhance the Michigan Department of Education’s (MDE) capacity to help teachers and districts.
The report does recognize these recommendations require “significant new investment.”
The Detroit Free Press reports the recommendations come at a high price tag, with estimates of $400 million a year for free community college and $900 million a year for more funding for at-risk students.
John Walsh, director of strategy for Governor Snyder, reported to CMF that the governor is now reviewing the many recommendations from the Education Commission and is expected to announce the five priorities he wants to address in the remainder of his term.
Digital Security with Grantees: Where Do You Begin?
As we collect and gather data to measure and grow our impact, protecting data and the sensitive information that may be flowing into our systems and those of our grantees is critical.
How can we ensure our foundations and our grantees are utilizing best practices for digital security safeguards and policies?
Earlier this month, Digital Security & Grantcraft Guide: An Introductory Guide for Funders, was authored by several foundations involved in the NetGain initiative partnership, to help foundations begin conversations around enhancing digital security.
The guide notes with growing technology, costs are dropping, allowing more people to access equipment they could use to monitor or hack data and information from nonprofits and other non-government organizations (NGOs).
“Even organizations engaged in work viewed as non-threatening to governments and non-state actors face a more dangerous digital environment due to the rise in cyber-based crime.”
There are ways grantmakers can help their grantees address these issues by having a conversation about their current capacity and identifying ways to improve.
The guide recommends identifying if a grantee or project possesses a high risk for a security breach by asking:
Does the grantee handle sensitive information that may be of interest to a potential group?
Does the project collect sensitive information?
Does the project involve creating a new database, website, etc.?
Determining the level of risk a grantee or project is facing will help guide the next steps for addressing any shortfalls.
However, the guide provides a framework grantmakers can use to improve digital security for organizations across the board, whether they’re high-risk or not.
Email: Encourage them to implement managed, coordinated email services rather than having staffers utilize their personal emails or accounts on different platforms.
Two-factor authentication policy: This adds another layer of security, requiring you to receive a text or email for a sign-on. The guide recommends Google Authenticator and/or YubiKey.
Work devices: Implement a policy that all work devices, phones, laptops, tablets, etc. are encrypted so if they’re lost or stolen an unauthorized user wouldn’t be able to access the sensitive data.
Documentation policy: Work with an IT expert to develop a policy and process for documenting suspicious emails, a loss of work devices, etc.
Develop a plan: Develop a response plan for the organization in case there’s a data breach.
Updated software: Without regular updates software is vulnerable to security breaches.
While it’s important to protect data, the guide acknowledges there are barriers organizations face in implementing and maintaining digital security, including the lack of digital security policies and procedures and dedicated staff.
It encourages funders to create pathways to increased digital security with their grantees by having conversations about their needs to ensure their sensitive data is protected.
Read the complete guide.
Learn more about NetGain.
CMF Members Head to Capitol Hill
Nearly 30 CMF members are heading to Washington, D.C. today for Foundations on the Hill (FOTH) 2017, to advocate on issues affecting Michigan philanthropy.
For more than 30 years, representatives of Michigan foundations have been visiting Washington to share our stories with members of Congress.
Over the next two days, our CMF group on the Hill will meet with representatives from all 14 congressional districts in Michigan, along with Senators Debbie Stabenow and Gary Peters.
Our foundation members will focus on several key issue areas for Michigan philanthropy, highlights include:
Stressing the importance of maintaining the charitable tax deduction for the charitable sector. Congress is expected to consider tax reform later this year.
Sharing the importance of simplifying the excise tax for private foundations. Making the excise tax a flat one percent would make it easier for many small private foundations to administer, allowing them to focus more on charitable giving.
Requesting the IRS implement regulatory changes to make it easier for foundations to make program-related investments (PRIs) in their communities.
Want to know what’s happening on the Hill? This year we’re getting an insider look at the action from FOTH in a CMF Twitter takeover.
Carolyn Bloodworth, secretary/treasurer, Consumers Energy Foundation and CMF trustee, will be tweeting, sharing insights from the meetings and activities on CMF’s Twitter account this week.
"For as long as I have been part of Foundations on the Hill, we have made it a priority to help our lawmakers understand philanthropy’s role in Michigan and how important it is to support tax policy that will encourage more charitable giving and provide real benefit to communities across our state," Bloodworth said. "Our goals for this year remain focused on simplification of the tax code and educating members of the Michigan delegation about the important legislation impacting philanthropy and nonprofits."
Follow CMF on Twitter and keep tabs on the conversation by searching #CMFontheHill and #FOTH.
Want to learn more about advocacy? Check out the Philanthropy Advocacy Playbook.