First Impressions on Governor Snyder’s Message re Health and Wellness; BMI Reporting?

For the full message delivered on September 14, go to: A Special Message from Governor Rick Snyder: Health and Wellness.

The message covers a lot of very important topics related to health and wellness:

• Infant Mortality & Teen Pregnancy
• Obesity, Nutrition, & Food Safety
• Wellness Programs
• Seniors
• Oral Health
• Tobacco Use
• Access to Health Care
• Veterans
• Technology
• Federally Qualified Health Centers
• Behavioral Health & Developmental Disability (including autism)
• Health Care Reform: The MI Health Marketplace (aka health insurance exchange)
• Blue Cross and Blue Shield of Michigan
• Persons covered dually by Medicare and Medicaid
• Improved Governance: Reforming the Michigan Public Health Code (including hints he might be supportive of greater use of nurse practitioners to achieve greater access to and to control costs of health care, the objective of HB 4774 which I have co-sponsored)

This covers a lot of very important ground, but what seems to have caught the public’s attention the most is the request that doctors monitor and report the Body Mass Index (BMI) of children. To address this concern, Dick Posthumus, Senior Advisor to the Governor and former Lieutenant Governor, on September 15 shared this insight:

“There has been some misinformation and confusion on the segment of the Governor's Health and Wellness message concerning the tracking of BMI (body mass index).  Please read the information below and note why we used the BMI. Most of all, please note that the recording of information is completely voluntary.

Why measure BMI?

Michigan’s obesity epidemic costs our state’s economy literally billions of dollars a year.

• In 2008, obesity-related health problems cost the state (and by extension, taxpayers) $3.1 billion.  If current trends continue, by 2018 we will have to spend approximately $12.5 billion.
• The cost to the state’s economy is even higher when private sector expenses related to health issues are factored in.
• Combined, lack of physical activity and poor nutrition is the 2^nd leading cause of preventable death.

Michigan’s overweight and obesity problem is getting worse.

• In 1995, 18 percent of Michigan residents were considered obese.  Today, it’s nearly 32 percent.
• Two years ago, Michigan was the 10^th fattest state in the nation.  Based on the most recent information available from 2010, we are now tied for 6^th.
• In total, more than two-thirds of Michigan residents are an unhealthy weight.
• In Michigan, overweight and obese have become the new normal.

Under the governor’s proposal, BMI reporting is optional, not mandatory, and it is only for statistical purposes so the state can track population trends and the overall health of the state.

• Information reported by doctors to the Michigan Care Improvement Registry is confidential.
• The state already collects information such as immunization records, which it has done since 1998.  Before the state started tracking childhood immunization, Michigan had one of the worst immunization rates in the nation.  Today, it has one of the best.
• Tracking BMI will help in the same way by allowing health professionals to study trends and getting the conversation started with parents.
• In Arkansas, former Republican governor and presidential candidate Mike Huckabee required collecting BMI information.  Governor Snyder’s proposal is optional.

Body Mass Index (BMI) is a reliable way of getting a snapshot of a person’s overall health.

• Although BMI is not a perfect measure for all people (such as athletes who are much more fit and active than the general public) and it is only one factor out of many that should be considered, the U.S. Centers for Disease Control considers BMI a reasonable indicator of body fat and weight categories that may lead to health issues.

This isn’t about telling people what they can or can’t eat, or forcing parents to make their children put down the video game controller and go play outside. 

• This is about tracking trends and getting the conversation started with doctors and parents.
• Overweight children often turn into overweight adults who are more likely to suffer from chronic heart disease, stroke, hypertension, Type II diabetes, asthma, colon and breast cancer, joint and mobility issues and depression.
• The governor is leading by example and has made his own stats available so the public can see his progress.  At 5’11” and 192 pounds, the governor has a BMI of 26.8 and is considered overweight.  He needs to lose 16 pounds to be in the healthy weight range.  Following his doctor’s advice, the governor has set a goal of losing 10 pounds as a first step to being healthy.”

This message will prompt a lot of work by legislators, department personnel, health care professionals, insurance companies and many members of the public. Let’s hope this results not only in a healthier Michigan, but also lower health care costs.

Health Insurance for Live In Friends – HB 4770 and 4771

House Bill 4770 prohibits fringe benefits provided by public employers from being offered to unrelated persons living at the same residents of a public employee.  The bill defines public employees as any person who is employed by the state, a county, city, village, or township.  An unrelated person is any person who is not::

• Married to an employee.
• A dependent of an employee.
• Not eligible to inherit from an employee under the laws of intestate succession in Michigan.  (Means a person not married to or related by blood)

House Bill 4771 prohibits circumventing the intent of 4770 through collective bargaining arrangements, by eliminating bargaining for benefits to be offered to non related persons at the same residence.

With the Michigan economy still in recovery, and taxpayers requiring accountability for the money that governments spend, health and fringe benefits provided to unrelated live-in roommates of employees is a luxury which Michigan can no longer afford.  Michigan's public employers have provided benefits that private sector employees would never have received.  Restricting live-in benefits is  a demonstration to taxpayers that the state will spend their money wisely and not continue to support such a disparate level of benefit between the beneficiaries and those who pay the for the benefits.

But these bills are about more than money. The Michigan Civil Service Commission (CSC) voted in January to re-define recipients of state employee health care benefits as "other eligible individuals," meaning any one roommate - in addition to spouses and dependents - could receive taxpayer-funded health care benefits. These benefits are estimated to cost Michigan at least $8 million annually The Civil Service Commission intentionally crafted the benefits such as to try to avoid the intent of the vote of the people of Michigan. The Commission has been irresponsible in awarding benefits without regard to the costs, and these bills are intended to send the message that the legislature which is responsible for balancing the budget must have a say in what the spending is.

Further, by the Civil Service Commission defining the benefits as it did, there need not be any of the usual trappings of a marriage, or civil union or any expression of commitment towards each other, but merely cohabitation, such as friends who simply room together for convenience and cost savings. This goes far beyond what even the most generous private company offers, and simply is not good public policy.

The CSC and other governmental entities' decisions to offer such benefits open up Michigan taxpayers to increased fraud, as roommates, friends and their children will be considered live-in partners to qualify for state employee benefits. We are doing the fiscally responsible thing by preventing this abuse.

These bills would not break any existing agreements because the changes would go into effect when the next contract is negotiated or the current agreement is amended or extended.

The bills include language that extends their effect to the greatest legal extent. In case the legislature has no authority over employees covered by the CSC (per Michigan Constitution, Article XI, Section 5), the Act will still be found constitutional. And should legislative authority extend to the CSC, at a later date, the Act will apply to them as well.

We have stressed accountability and efficiency in every state program, as we seek the highest return on the taxpayers' investment. These bills protect the taxpayers.

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Getting the most with our Bridge Card Programs

This fall the members of the State House will be looking at ways maximize the benefit of the Bridge Card program with the introduction of House Bills  4721, 4722, 4723, and 4724.

These bills were introduced as a package of bills designed to curb fraud and abuse of the Bridge Card Program.  The Bridge Card program currently provides food assistance to many Michigan families.  One of the challenges of providing this hand up to families who need this assistance is also preventing fraud and abuse of the programs and protecting Michigan's taxpayers. 

Recent reports have highlighted some of the fraud that has been experienced including:
• Purchasing non-essential items such as lobster, pop, and junk food;
• Using ATM's to make cash withdrawals at inappropriate venues such as casinos;
• Selling Bridge Cards to other persons for cash;
• Persons remaining on assistance despite having warrants for their arrest, being incarcerated and having won the lottery.
• Disguising the card to hide the fact that it is a Bridge Card.

House Bill 4721 prevents welfare recipients with outstanding warrants from receiving benefits.  Lawless individuals on the run should not be supported in their efforts by the state.  Michigan Police Officers are working hard to track these individuals down, and taxpayers will no longer provide them safe haven.

House Bill 4722 prevents recipients from withdrawing cash from their Bridge Cards at casino ATMs.  Cash assistance is meant to help families in need find a way through turbulent times until they find work.  It is not meant to pay for parties at the casino or luxuries like alcohol and tobacco.

House Bill 4723 requires DHS to cut off benefits for currently imprisoned recipients.  There is no legitimate reason for prisoners to have Bridge Cards.  Cash assistance is meant for those who have no other means of making ends meet.  Prisoners have their needs met by the state corrections system and do not need Bridge Cards to pay for essentials.

House Bill 4724 requires recipients to pay for replacement Bridge Cards, after their first one.  Bridge Cards are often traded for non-essential items, undermining the purpose of the program.  Requiring participants to pay for their own replacements will help curb this sort of fraud and ensure needy families spend their assistance on the essentials.

Together these common sense reforms enable families to receive the help they need in times of hardship and also serve to assure the taxpayer that their money is being directed efficiently to needy families and not used for fraud and illegal activity.  Eliminating fraud and waste also leaves more funds available to families who are relying on the program and allows a much more responsible use of taxpayer funds.

2011 Legislative Accomplishments

It's been a busy year at Michigan's Capitol as we, the members of the 96th Legislature, have taken it upon ourselves to undo a decade's worth of poor fiscal planning and failed economic development.

When I was called upon to represent our community I knew that I would have to make many difficult decisions. There are no perfect solutions or quick fixes, and the path to prosperity requires that we take a realistic look at the policies that shape Michigan's present and future.

Here is a summary of some of the major steps we have taken to get our state back on track.

It’s All About Jobs

My main goal in running to by your state representative was to create a better business climate to create jobs. Stable employment is not just the cornerstone of the American dream, but also the foundation of a healthy economy. The relationship is simple: the health of the public sector is dependent on the health of the private sector, the source of all original revenue. When the private sector is healthy there are more lobs, and the state thrives. When there are more jobs, there are more public funds for education, public safety and human services.

For years, state government has put excess regulatory and tax pressure on job providers and small businesses, forcing them to lay off employees just to stay afloat. In some cases, businesses have had to shutdown altogether. Our state must look out for job seekers and job creators, as both are crucial to Michigan's vitality. We must make Michigan a competitive place to do business.

The Legislature's job-friendly accomplishments so for include:

• Simplified Michigan's tax code to make it more efficient and more predictable for job creators, minimizing risk and encouraging expansion. This includes ending double-taxation on small businesses and creating a flat corporate tax rate.
• Ended the old practice of creating niches for special interests and using tax credits to pick winners and losers among prospective businesses. Every job provider that wants to operate in Michigan should be able to do so on equal footing.
• Preserved funding for programs that have proven to spark economic development, like the Pure Michigan advertising campaign.
• Addressed outdated, burdensome regulations that place additional costs on job-creators, such as Michigan's item-pricing law.

Giving Local Governments the Means to Stay Solvent

Building strong communities must start at the local level. The greater the cooperation between state and city governments, the stronger both will be. The Legislature has given municipal government the tools to address common concerns and to manage their finances.

Reforms geared towards local success include:

• Passing the Fiscal Accountability Act to help local governments stay solvent by giving them the tools to avoid bankruptcy and address rising costs. This Act has already enabled one city, Benton Harbor, to go from a budget deficit to a surplus.
• Updating binding arbitration laws to prioritize affordability during negotiations.
• Facilitating consolidations and service-sharing for local units, allowing for greater government efficiency and preserving critical services during times of financial difficulty.

Ending an Era of Fiscal Failures

For the past decade, state legislatures seemed to have done everything in their power to avoid balancing the state checkbook. This year, the 96th Legislature faced down a deficit of over $1 billion and an economy struggling to pull itself together.

The public made it clear that enough was enough, so the new state government got down to business immediately by passing a complete and balanced budget which was:

• The realization of many needed structural reforms.
• Several months ahead of the September 30 budget deadline.
• Based on years of continuous revenue decline.
• Data-driven and geared towards long-term growth and solvency.
• Built to prioritize areas of importance, such as education and public safely.
• Designed to create a foundation for job growth and economic development.

Taking a Close Look at State Spending

In order to keep state spending solvent and prevent increasing costs to taxpayers, the House is also looking at government spending throughout Michigan with the goal of finding reasonable solutions to rising costs at the state and local levels.

Some important reforms include:

• Putting limits on taxpayer liability for public employee health care plans.
• Bringing Michigan in line with surrounding states by placing a permanent, 48-month lifetime limit on welfare assistance for able-bodied individuals. This will help break the cycle of dependency while reducing taxpayer burdens.
• Preserving state assistance for those who need it most by limiting fraud and abuse in the Bridge Card system.

Putting Our Own House in Order

My colleagues and I share the belief that working on behalf of the public is about service, not reward. To that end, the House of Representatives has worked to reduce internal spending so that we can bring public employee compensation and benefits, including those for legislators and their offices, in line with those of the private sector.

Though the Legislature represents a minor portion of the overall budget, we believe we must lead by example when it comes to reducing the cost of government on taxpaying residents. With this in mind, the Michigan House has made the following internal cost-savings:

• Enacted a salary reduction of 10 percent for all lawmakers.
• Enacted office budget reductions, from which legislative assistants are paid, by 5 percent at the start of this year, with an additional 13.9 percent decrease beginning January, 2012. Effective October 1, 2011, member offices will be limited to only two full-time assistants.
• Enacted budget reductions of 7.5 percent and 5 percent to partisan central staff and non-partisan office staff respectively, effective October 1, 2011.

Choices and Consequences; The Way Ahead

We knew that we needed to make choices that would not please everyone. I believe we have made a good start to a more prosperous Michigan and a more solvent Michigan. We have much more to do, but I feel very privileged to be a part of this legislature which has already accomplished a great deal.