Michigan Votes Forum

Introduced in the Senate on February 13, 2008, the Senate version of the Fiscal Year (FY) 2008-2009 Department of Community Health budget. (Gov. Granholm’s recommendation for this budget is contained in Senate Bill 1141). This would appropriate $12.482 billion in gross spending, compared to $12.048 billion, which was the FY 2007-2008 amount enrolled in 2007. Of this, $7.159 billion is federal money, compared to the FY 2007-2008 amount of $6.708 billion, and $5.323 billion is from state tax and other revenues, compared to $5.300 billion enrolled the previous year. Among other things, the budget does not include Gov. Granholm's proposal for "mental health courts," and would eliminate Medicaid coverage for 19- and 20-year-olds living in low income households

The vote was 20 in favor, 18 opposed and 0 not voting

(Senate Roll Call 200 at Senate Journal 31)

Click here to view bill details.

Senator Cherry’s statement is as follows: I rise to express my opposition to this bill and to urge other members not to support it. As you’ve seen through the few hours we have spent on this budget, there are serious problems with it. We have done a number of amendments to point those problems out; they include the fact that the Healthy Michigan Fund has been cut in half and rolls up all of those items into one line item. It cuts the Medicaid to nineteen- and twenty-year-olds funding. It cuts money for the MiChoice program because it does not recognize the savings that would occur if that program was funded, and potentially overfunds this budget by at least $12 million, if not more. This is because nursing homes can overspend their budgets and we have to pay that cost whether or not we have planned for it. That is not, in my mind, in and of itself an unbalanced budget. We have had a number of initiatives that have been partially funded in this budget, but not fully funded, and there is a significant amount of boilerplate in the budget which could cause a problem and increase the cost to the department in administration. Just a small example of one item we did not address was this budget cuts all the classified personnel salaries by half, and we know that cannot be sustained throughout the whole budget process. So there are significant problems with this budget, enough, I believe, that makes it a budget which is very difficult to support right now. Because of the services that are going to be cut through this budget, I am urging people to vote “no,” I will be voting “no.”

Senator Switalski’s statement is as follows: You know, you can agree or disagree with the bill, but you have to admire the way Chairman Kahn has fashioned this budget. The good senator has put before us his vision of a CMH budget and has made aggressive changes. During these times of static funding and continuation budgets, he has offered a series of choices that substantially depart from business as usual. This budget challenges us to consider big changes. I asked the chair to increase reimbursement rates to primary care doctors. There is a shortage of primary care doctors. He agreed and he raised reimbursement 40 percent, so how can I criticize that? He did what I asked, and he did it in spades. There are other good things in this budget; the first increase to local public health in 10 years. There are increases to pharmacists and long-term care. So there are many good things in this budget. I must reluctantly vote “no,” however, because of the cut to Healthy Michigan and the elimination of nineteen- and twenty-year-olds from Medicaid. I know this is a process and I have found Chairman Kahn to be a fair-minded and generous person. I count myself lucky to have such an open-minded chair to work with, and I look forward to narrowing these differences and fashioning a bill I can enthusiastically support.

Senator Scott’s statement is as follows: I will be voting “no” on this budget. You may have increased the budget, but there are some amendments that we did not pass today that I think are very, very important to our most vulnerable population—our children and our mentally ill. So until we get a real grasp on who it is we need to be taking care of, then I will continue to vote “no” on these kinds of bills. I would think that my colleagues, certainly, the mentally ill, our children with the STDs, and our children who will be going to the emergency room for their dental care, that we would put the proper funding in these budgets that will take care of these people who cannot take care of themselves. So I want my remarks printed in the Journal, and I would encourage my colleagues to vote “no” on this budget.

Senator Clark-Coleman’s statement is as follows: I rise to speak in support of the Healthy Kids Dental Program. This is a program created for the Medicaid-eligible children in the state of Michigan. Since the healthy and the well-being of our children are two of our top priorities here in this chamber, I feel compelled to speak to this important initiative. Attesting to its importance is the fact that fifty-nine counties in our state are already participating. The fact that Wayne County, the county with undoubtedly the greatest need, is not a participant in the Healthy Kids Dental Program is a grievous omission, and it is one that we must correct. Therefore, I am recommending just a one-month trial of the healthy Michigan dental program in Wayne County to begin in July of 2009. Now we all talk the talk for health for our children here in Michigan. We now must walk the walk.

Senator Brater’s statement is as follows: Mr. President, this amendment is intended to restore the money—$2 million and some dollars—to establish mental health courts which would be part of a mental health diversion program in the state of Michigan. As you all know, the closure of our mental hospitals in the 1990s resulted in a tragic trans-institutionalization when the good objective of getting people out of hospitals settings and back into the community was not realized because the money did not follow people with mental illness from the hospitals back into the communities. They ended up falling through the cracks and often languishing in the community without treatment, without medication, and sometimes without homes or other support services and ending up with contact with law enforcement, often on minor offenses such as trespassing, creating a nuisance, or urinating in public. They would end up incarcerated and escalating from jails to prison because of the inability to comply with jail or prison rules. Now, first of all, I would like to thank Governor Granholm for putting this money into the budget. It was a very historic step on her part to recommend this money and to reverse this tragic trend that we are engaged in the state of Michigan. I would also like to thank the chair of the Community Health Subcommittee for his—what I think is his—commitment to this objective of making sure that our most vulnerable citizens are receiving treatment that they need for a disease or a chronic illness, rather than punishing them by putting them behind bars on what, as I said, can statistically be shown to be a most cases a minor, nonviolent offense. But I think we are compounding the tragedy by using people with mental illness as a bargaining chip in this budget. This is unacceptable behavior. It is hard to find a family in the state of Michigan who statistically is not touched by this disease, and it is high time that we take this opportunity that the Governor has handed us and fund this program to prevent people with mental illness from being put in prison for no other reason than that they are ill, that they have a chronic illness. Now the minority vice chair of the Appropriations Committee earlier made reference to the funding source for this program, which would be finding some efficiencies by forming a risk pool for the mental health ward that they could fund their liability jointly, but the $7 million that that would save should all go back into mental health treatment. There is already this funding for this treatment that has been flat since 2002, and one of the reasons the people are being penalized is there are not enough treatment dollars being spent on treatment in the system. So we must find a way to get that money back into the treatment system so that when people present themselves for services, they are not being turned away, and then in a more acute phase off, their medications and end up tangling with law enforcement. So I want to thank also the good chair of the Corrections Subcommittee who has also shown a great deal of interest in this issue and has worked with me to try to get training dollars for law enforcement personnel so they can recognize the symptoms of a person with mental illness and get them back into the mental system. But none of this will work unless we get the treatment dollars spend in the right place. So, I am standing here imploring you—I have been talking about this, as you know, since I came to the Legislature in 1995. A lot of you are probably tired of hearing me recite the facts of this situation, but it has not gone away and it is not getting any better and it won’t get any better today if you vote “no” on my amendment. So I am asking you out of your sense of humanity, out of your compassion for people who are ill, who are being victimized in jails and prisons instead of getting treatment that they need. Please vote “yes” on this amendment.

Senator Kahn’s first statement is as follows: Indeed, as the Senator from the 25th District points out, we have discussed this issue before. The essentials of the issue before us with this amendment are a balanced budget for the state of Michigan with different areas and our abilities to fund them. In identifying places where we cannot cut, sending people home from nursing homes on ventilators without care when they are best cared for in that environment with support staff is a priority. That priority was not recognized in the budget that we were handed. In recognizing that authority, we in the Senate are serving truly our most vulnerable people. In making that decision, we needed to find other areas where we could sustain the cut. One of those areas is identified by the administration last year—the Healthy Michigan Fund. As the Senator from the neighboring county—the Senator from the 25th District—points out, as we identified that area for savings and cuts, we did it with the compassion to roll the line item up and allow the administration to participate in the decision of where those dollars might be best spent. Yes, it’s unusual for us as appropriators to give that particular authority to the administration, but if we were to make those sort of reductions in conjunction with the recommendations that the Governor had last year, it is my feeling that we ought to do it with part of it allowing them to participate in locating the areas in which those cuts are to be made. So I am saying that I oppose this amendment.

Senator Cherry’s first statement is as follows: This amendment is one that we have talked about many, many times and it has to do with the Healthy Michigan Fund. As you know, as we have talked about earlier, this budget cuts the Healthy Michigan Fund almost in half and rolls up all of the line items which delineate the programs that are funded by the Healthy Michigan Fund. So that you understand the programs that would be impacted by this—let me just tell you about a few of them. One is the Alzheimer’s Disease Outreach and Education Program; another is the Cancer Prevention and Control Program; cardiovascular chronic disease prevention programs; dental programs; anti-diabetics programs; huntington’s disease programming; immunization programming; infant mortality programming; lead poisoning programming; nurse family partnerships programs; physical fitness, nutrition and health education; pregnancy prevention programs; and anti-tobacco, anti-smoking prevention programs. So, Mr. President, thank you. I just wanted to outline how important it would be if all these programs got cut. They are as you know, very important to all of our citizens. One of the things that I also want to point out is that as we roll these programs up into one line item, the Senate potentially will never know what is being funded through this program. I think it is important for us to know what the Healthy Michigan Fund funds, what programs are funded, and it is important that we continue to fully support these programs. They are some of the few programs that each one of our communities has a say in. Our communities are involved, for hundreds and thousands of volunteers are involved in these programs and it is important that they continue. I ask members to support this amendment, and again, I hope that we would be wise in our judgment and adopt it. Senator Cherry’s second statement is as follows: I only add that this budget, as proposed by the Governor, did recognize the need for care to our older adults—long-term care both in and out of institutions. It also provided fund for the Healthy Michigan Fund. I believe that it is important for us as the legislative body to have oversight over the administration no matter what party is in control of the administration. By not rolling these line items up, we have oversight in what gets funded through the Healthy Michigan Fund. Again, I ask members to support this amendment.

Senator Kahn’s second statement is as follows: I rise in opposition to this amendment. We’ve seen that the budget that was initially proposed with the estimates that are initially available to the administration had approximately $100 million worth of holes in it, which included over $50 million in the Medicaid benefits trust fund; a reduction of $5 million in one of our risk pools which takes care of indigent people. This particular amendment, which shifted $30 million from taking care of folks within nursing homes to the waiver program and several other areas, at the end of the day, it will be very nice to fund this increase at the over $300 million requested by the administration. We have increased it by $1 million, which keeps the issue alive. We also have found other ways to spend those dollars that deal with more vulnerable populations, as mentioned just a moment ago. When you are dependent on a ventilator, when you need 24-hour-a-day or nearly 24-hour-a-day care, if that care is to be degraded or absent, your quality of life and the quality of life of your loved ones suffers almost to the level of intolerability. We’ve seen that as we go to expand home care and are looking at the single point of entry pilots, the ability to transfer people from nursing homes to home care has not been reported along with how many stay home once they get home. That is an issue that goes to the bureaucracies, to the quality of care, and to the dangers of transitions. These are all issues that go to the fringes and yet the soul of waiver expansions. For those reasons, I oppose this amendment.

Senator Cherry’s third statement is as follows: This amendment is a little complicated. The Governor shifted funds from institutional long-term care into community-based care, and that helped recognize the savings that would occur in long-term care because there was an effort to keep people living in their own homes. The budget that is before you cuts the funds for long-term care institutional funds, but it does not put the savings back into the community and home-based program, as was stated earlier. There was a desire, I think, on the part of the chair to put that money in other places. However, when that is done, that has the potential to increase this budget as a whole because under Medicaid rules, if the long-term care institutional programs actually spend more money than what is in the budget, we have to fund those programs. So even though this budget looks like it is under the Governor’s recommendation and meets the Senate Republican target, there is a problem with the basic funding because it has the potential of increasing the nursing home care funding. Mr. President, this budget simply restores it back to the Governor’s recommendation so that there is money and the savings that occurs from the change in institutional care actually does go into long-term care and into the MIChoice program, so that services can be provided to our older adults living in their own homes. I ask the members to support the amendment. It is good policy for this state to be providing more alternatives to institutionalization, and this actually provides the funding for that to occur. Senator Cherry’s fourth statement is as follows: This amendment is another one that we often argue about in this chamber. This is an amendment to restore the Governor’s proposal that includes funding Medicaid for low-income nineteen- and twenty-year-olds. This is something that Michigan has determined do to over the past years because in the long run it saves money. Why does it save money? Because young adults generally will go to the emergency room for the care that they need and that costs us even more money. While we have talked about the risk pools, which is money that goes to the hospital, we would save those hospitals more money if we adopted my amendment so that nineteen- and twenty-year-olds could get the services that they need through Medicaid rather than going into the nursing homes. In addition, there are young adults who are aging out of foster care who are covered by this program. I don’t think that we wish to have those young adults without health insurance. They need it. We should be providing it, and we would make sure that emergency rooms are not the place that they get the health care that they need. So, Mr. President, I ask the members support this amendment so that we could actually save the state money and that we again show our wisdom within this body and adopt this amendment.

Senator Kahn’s third statement is as follows: I appreciate the remarks of the Senator from the 25th District. In brief, she states that by maintaining the nineteen- and twenty-year-olds it would be cost-effective as they seek their care in the emergency room, and I would like to address that issue, but before we address that issue, we need to address another issue. That is, a budget that is balanced, how to get there, a $100 million hole in that budget as it is presented to us, and what options we have. The option that we have before us of eliminated nineteen- and twenty-year-olds is a road well traveled. It is a road traveled by the administration itself two years ago when they eliminated nineteen- and twenty-year-olds from the budget; they are an optional population. The reason nineteen and twenty year olds are there today is not because of the administration. They are there because the federal government did not allow the plan amendment that would allow for the method of elimination of them. They would be gone today, and as we looked for a way to do that, this is exactly that—a way to do so. Let’s talk about seeking care in the emergency rooms, another point made by the good Senator from the 25th District. Within the budget, we have placed a considerable about of money to deal with well-child visits and to deal with the primary care visits and to deal, therefore, with access to care within our rural, and in particular, within our urban areas, which are areas where there is a particular shortage of physicians and a particular likelihood that someone will seek their care in an emergency room. So the amendment in which I urge you to defeat is also the source by which we are going to increase the availability of care for our young people, our children, our adults, and our aging in our urban course. I urge a defeat of this amendment. Senator Kahn’s fourth statement is as follows: This, too, is a ground that we have traveled before. Let me review this and also lay out, if I can take the time. I’m sorry for those who would wish I would be briefer. How we might go about expanding Healthy Kids Dental Program in the future. The issue that we have before us is where are we going to find new funds for new programs in a budget that is overspent at the time that it was delivered to us. Insofar as we’ve been able to deliver any new programs, they have been generally small, pilots, people-focused, or wage-related or improving access of programs. There have been some changes to the Healthy Kids Dental Program. One of the outstanding counties, a small county, has been added. A principle was established today, I believe, in how we might go ahead in the future. This is important. The Healthy Kids Dental Program in the past has expanded county by county by county. Today we approved a noncounty municipality. I believe that gives us the method by which in the future we can add either Wayne County by parts Macomb County, Livingston, Kent, and the large counties like Oakland that are in need of this program, as Senator Scott so rightly identified. We need to work on how we’re going to deal with the municipality issue and expand a Healthy Kids Dental Program in coming years and possibly if there is money available this year, as per the revenue estimating conference in May. At this time, this amendment is a budget buster. The idea has merit, but it cannot be supported at this time, and I urge its defeat. Senator Kahn’s fifth statement is as follows: I appreciate the remarks, again, by the Senator from Wayne County. You know, the issues of STDs are something that physicians learn almost from the moment that they enter medical school. In my particular case, there is something called a con test, which was one the original tests done toward the turn of the last century for syphilis. Finding funding for these diseases which lead oftentimes to the loss of fertility, certainly lead to the potential for loss of life, is clearly of importance, something we all recognize and something which is vastly addressed, historically speaking, in our country either at the hands of the individual physician in his office or by the public health department. This year we placed an additional $1 million within the funding for the health department, over and above that requested by the administration. That health department funding can be directed, if the health department so wishes, towards two burgeoning areas of need: one, in high-risk infections such as methicillin-resistant staphylococcus aureus or streptomycin-resistant enterococcus or, in this case, with STDs. The funding within the health department addresses some of the concern, and certainly, we can address it further if there is a need. I urge the defeat of this amendment.

Senator George’s statement is as follows: I rise to speak in favor of the budget, and I just want to point out a couple of important features. We have heard all the concerns over the need to properly fund Medicaid, mental health, dental coverage, hospital payments, payments to providers, and the need and obligation we have to provide care for the poor and the disabled. I would just point out that this budget shows an increase in $134 million, almost a half-million dollars over the current budget. It is rising from $12 billion to nearly $12.5 billion, and yet, it is never enough. It speaks again to the need to control health care costs by having a healthier population. If only we had a healthier population, most of our woes here would be lessened. The chair has done his best to balance the needs that we have to meet making a balanced budget and providing that care. I want to point out a couple of innovations that the chair has included in the boilerplate language that get to the root cause of the problem. One is a provision that would require enrollment of pregnant women into HMOs. They know that currently they have the option of choosing the fee-for-service plan, and, of course, the fee for service plan has no managed care and has no capitation payment and has no incentive built in to constrain costs. It turns out that within Medicaid, the single biggest diagnosis and the single biggest cost to the state within Medicaid is the care of pregnant women and then their childcare. So if we can enroll those new Medicaid recipients into HMOs, which have an incentive to control the cost to get them to their prenatal visits to reduce the risk of premature birth, then we will be doing ourselves a favor. The chair has included that in boilerplate language. That is an important piece that has been overlooked. I would also point out boilerplate language relating to creating a ban on tobacco in psychiatric facilities. I would note that the Corrections Department has recently adopted such a ban, and I support that. Clearly, if we look at the Corrections budget, we would see that a rising piece of it is health care expenses. Well, here we have had a debate over funding for mental health. Is it enough or is it not enough? What can we do to have more? You should know that the incidence of tobacco smoking and tobacco addiction is very high among the mentally ill, and we currently allow them to smoke in our psychiatric facilities. You should know that there is a movement to stop that among these psychiatric specialists. You should know that it has been a practice for some time to use tobacco as a reward in treating patients in psychiatric facilities, and consequently, some of them smoke two or three packs of cigarettes a day. They die at an earlier age from heart disease, stroke, etc. So here we have a measure that is going to directly address that. So, colleagues, I support the bill before us. It represents the realities of the budget that we face, and the chair is to be commended for including innovations like these that hold the hope for creating a healthier Michigan.

Senator Basham’s statement is as follows: I really appreciate and agree with the good Senator from the 20th District. I think he makes a lot of sense. That’s why I think colleagues should take up those languishing bills setting in Government Operations which deal with secondhand smoke. I agree with the good doctor, and I agree that we could do more. We seem to talk about small things in a budget and eliminate conversation about something that could save the state billions of dollars when it comes to secondhand smoke. Thirty-two states have gone smoke-free. Other countries have gone smoke-free. The United States Surgeon General said there is no safe amount of secondhand smoke. We agree that we should do things to make Michigan healthier. One of them would be not to expose people who don’t want to be exposed to secondhand smoke. I think it’s certainly appropriate to have that conversation in this budget bill when it comes to community health. So if 32 other states can do the right thing, I absolutely agree with the Senator from the 20th District that we need to be talking about things that we can do to make Michigan a healthier state. So I appreciate his remarks.

Senator Kahn’s sixth statement is as follows: Now we come to the time to move the process forward on this budget, move it from this chamber to the other chamber for further consideration. I ask my colleagues here for their vote to pass this bill. It is a good bill. In talking about areas where it could be different or better or both, we’ve lost sight of some of the things that are present here within the bill. This $12.5 billion bill, which is a $400 million increase over last years’ spending, and $400 million represents the size of many state departments. This bill cares for the folks on Medicaid, it keeps our HMOs actuarially sound, and deals with some of the problems that were necessitated by the additional presentation of this bill, which contained about a $100 million hole. Well, the bill as originally presented eliminated the $5 million risk pool which would have left indigents, people without any health care insurance who presented to hospitals without any way of being made whole or the hospitals made whole. That was restored. That prevents the degradation of care in our hospitals. This bill also increases a reimbursement to pharmacists. Pharmacists have seen a steady decrease in their reimbursement. Do we get them back to where they were a few years ago? No. We got them up to a point now where I think we can ask them to participate in consultations and the use of their time in making decisions about appropriate medication choices. We also have increased the availability of health care in our urban centers and our rural centers by virtue of increasing fees paid to the physicians, who have left those areas because of their cost of doing business is higher than their compensation. This is a big plus. We put a two percent increase in the fees paid for mental health direct care workers’ the first time they have seen an increase in centuries. We put an increase of $1 million of local public health dollars; something not targeted by the administration and again not seen for many years. This can address some of the issues that we have with infections of some types that we have talked about earlier, whether they are in the venereal disease family, the STD family, or whether they are the high-risk resistance organisms. We have initiated pilots for traumatic brain injuries, and we have dealt with tobacco use in psychiatric facilities, as mentioned. Some of our most costly and most vulnerable populations, I think, we would all agree are pregnant women and neonates, and we have served to make them to be able to have preventive care and the best possible opportunity for a healthy birth, for both mother and child. We have dealt with some of the cuts that were inflicted upon our nursing homes, which would have degraded their care and would have made them whole as well. We have looked to the future with something that we all know is coming—electronic medical records and electronic prescribing. So this budget, which I urge you to pass, deals with some of the issues that we have to deal with every day with our budget challenges. It keeps our faith with our Medicaid population as a whole—looks to the future and adds to programs. I ask for its acceptance and that it be passed out of this chamber into the next.

Rep. Caswell, having reserved the right to explain his protest against the passage of the bill, made the following statement: “Mr. Speaker and members of the House: This bill spends $30 million more than the Governor in GF. We can’t afford it unless we have another tax increase.”

Rep. Schuitmaker, having reserved the right to explain her protest against the passage of the bill, made the following statement: “Mr. Speaker and members of the House: While I support many programs in this budget, as a whole it has severe problems that need correcting. I cannot ignore the lack of reforms and new structural deficits this bill creates. The FY 2008-2009 budget is dependent on the Democrats’ $1.4 billion tax hike as well as several one-time funding gimmicks. If we allow spending to go unchecked, we will have to raise taxes again in the near future. The director of the non-partisan House Fiscal Agency has said we cannot afford the spending. The House Democrat budget is even higher than what the governor proposed. I refuse to support spending we cannot afford, especially since doing so will set the stage for another tax hike. Not enough was done last year to cut waste and reform government, and as a result taxes went up. If we want to fix governor’s proposed level of our economy, we need to get our spending problem under control. This budget does not do that. For these reasons, I cannot support this bill at this time.”

Senator Kahn asked and was granted unanimous consent to make a statement and moved that the statement be printed in the Journal. The motion prevailed. Senator Kahn’s statement is as follows: This budget represents $12.5 billion worth of expenditures of which $3.1 billion is General Fund monies. Michigan has had a tough century and a lot of dollar shortfalls and this year being no exception. It is also no exception that the Department of Community Health budget has had to be cut, so the provision of services to our most vulnerable citizens, while at the same time recognizing our fiscal constraints, has been the balancing act in this budget as in many others. Within those confines, we have been able to preserve actuarially-sound rates for our community of mental health and for our HMOs. We have found the funds to avoid making cuts in the Healthy Michigan Fund and eligibility groups; and at the same time, came up with a few dollars for some new programs and for recognition of needy workers in the state of Michigan. In so doing, we have a 1 percent wage increase for community mental health direct care workers. We have found monies to support a free medical clinic in Bay County. We found dollars to deal with sexually transmitted diseases and for a traumatic brain injury hospital project. We found a few dollars for school-based health clinics and for physicians who for years have actually paid for the privilege for seeing Medicaid patients as they are reimbursed below cost and will be receiving a small increase which we hope will encourage them to continue to participate in Medicaid and approved access to care. Those findings were achieved in a bipartisan fashion with the help of my vice chairs, Senator Pappageorge and Senator Cherry, both of whom I thank along with Senate Fiscal and my staff Stephanie Shooks. I urge the passage of this bill, which was reported unanimously from the conference committee.