Michigan Votes Forum

Introduced in the House on February 24, 2009, the House verson of the Fiscal Year 2009-2010 Department of Community Health budget. This would appropriate $13.481 billion in gross spending, compared to $12.533 billion, which was the FY 2008-2009 amount enrolled in 2008. Of this, $8.960 billion is federal money (which includes $936 million of “stimulus” deficit spending), compared to the FY 2008-2009 amount of $7.225 billion, and $4.460 billion is from state tax and other revenues, compared to $5.323 billion enrolled the previous year

The vote was 65 in favor, 44 opposed and 1 not voting

(House Roll Call 164 at House Journal 0)

Click here to view bill details.

 

Rep. Kowall, having reserved the right to explain her protest against the passage of House Bill No. 4436, made the following statement:

“Mr. Speaker and members of the House:

While I support many programs in this budget, I cannot support it because it is based on numbers we already know are faulty.

We are facing a $1.6 billion budget shortfall next year and a nearly $800 million shortfall this year, and the problem is growing larger all the time because the state is taking in $5 million-a-day less than expected.

This budget not only fails to address our structural budget shortfall, it actually adds to it by spending nearly $300 million more than the governor’s recommendation for new and expanded programs.

There are many lawmakers who want to take the easy way out by using federal stimulus funds to fill our budget hole, but this is a bad idea because a year or two from now when the money is gone, all we will have to show for it is another budget deficit and more national debt. Stimulus funds must be used to create jobs.

We need to make real reforms now and reduce spending now. If we don’t get our budget mess under control, we can’t do the things we need to do to attract jobs to our state and fix our economy.

For these reasons, I cannot support this bill at this time.”

 

Reps. Meekhof, Agema, Hildenbrand and Haines, having reserved the right to explain their 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, I cannot support it because it is based on numbers we already know are faulty.

We are facing a $1.6 billion budget shortfall next year and a nearly $800 million shortfall this year, and the problem is growing larger all the time because the state is taking in $5 million-a-day less than expected.

This budget not only fails to address our structural budget shortfall, it actually adds to it by spending nearly $300 million more than the governor’s recommendation for new and expanded programs.

There are many lawmakers who want to take the easy way out by using federal stimulus funds to fill our budget hole, but this is a bad idea because a year or two from now when the money is gone, all we will have to show for it is another budget deficit and more national debt. Stimulus funds must be used to create jobs.

We need to make real reforms now and reduce spending now. If we don’t get our budget mess under control, we can’t do the things we need to do to attract jobs to our state and fix our economy.

For these reasons, I cannot support this bill at this time.”

Rep. Genetski, 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:

I respectfully can not vote for a budget that is $300 million dollars more in spending than the governor asked for in a year during which the state has almost an $800 deficit.”

 

Senator George, under his constitutional right of protest (Art. 4, Sec. 18), protested against the adoption of the amendments offered by Senator Brater to House Bill No. 4436 and moved that the statement he made during the discussion of the amendments be printed as his reasons for voting “no.”

The motion prevailed.

Senator George’s statement is as follows:

I rise to speak against the amendment. It is with regret that I will be voting against it, and, in fact, it was my legislation which helped to create the pharmaceutical purchasing plan. It is true that we carved out certain categories of medications, including these. It’s just an unfortunate reflection of our times and our overall budget woes that we have to leave no stone unturned in finding a way to balance our budget in light of our declining revenues.

Though we would like to not have any preferred drug list at all, it’s just not in fitting with the times. In fact, in commercial insurance plans which many workers would have been provided by their employers, they would have preferred drug lists which would include drugs used to treat mental illness. So I understand the arguments in favor of the amendment, but they’re just outweighed by the budget reality of the day.

If we had benefited from a better federal Medicaid match rate, then we could afford, perhaps, to do things like this. But, unfortunately, despite our high unemployment in Michigan, our federal Medicaid match rate has not increased proportionately to allow us to afford such things as this.

So, unfortunately, I would like to give that as my “no” vote explanation.

 

Senator Cherry, under her constitutional right of protest (Art. 4, Sec. 18), protested against the passage of House Bill No. 4436 and moved that the statement she made during the discussion of the bill be printed as her reasons for voting “no.”

The motion prevailed.

Senator Cherry’s ninth statement is as follows:

I cannot in good conscience support a budget that robs programs aimed at prevention, that robs the protection of the health of our communities in the long term, and that does not assist people who are too poor to afford health care for themselves and their families. Making cuts to the state budget has been a difficult process for all of us; however, most of the cuts made so far, while I have opposed many of them, have not been life and death—drastic cuts to community health very well could be for some of our Michigan residents.

First of all, in prevention, education is a key element of the prevention. In order to stay healthy, we need to understand the measures we can take in our daily lives to prevent illness and injury. Funding prevention programs will significantly reduce health care costs in the long run and the Healthy Michigan Fund which provides such services as cancer screening and smoking cessation are just an example of that. A healthier population is one that relies less on state health care programs. If we can head off health threats in the early stages, we can save lives and cut health care immediately.

The other issue for this budget that I am so concerned about is mental health. Mental health funding is in jeopardy in this budget. Many people feel that mental health is not that important and that treatment for mental illness is not a necessity. They are wrong. Mental health is intertwined with physical health, and those left untreated will suffer just like anyone else who is chronically or terminally ill. Many Michigan citizens who previously had health insurance are now uninsured and looking to community mental health for help. While Medicaid funding provides some help to those who are eligible, there is a group of uninsured and under insured who do not qualify for Medicaid, and they depend on non-Medicaid, community mental health funding to get the treatment they need. That has been put in great jeopardy in this budget.

If left without proper care, these people lose their ability to work and care for themselves and their families, and they lost the ability to remain independent. Unfortunately, many of those who enter the criminal justice system suffer from untreated mental illness. Cutting services may save the state money, but it drains local agencies that must pick up the slack, and it floods the corrections system with offenders who need treatment, not jail.

Medicaid is another program we can’t afford to keep cutting. Slashing the Medicaid provider rate will reduce access to health care for those already struggling to find a provider who will treat them. Doctors are already limiting the number of Medicaid patients they take in order to keep their businesses afloat. Cutting compensation will drive more Medicaid patients to seek emergency room treatment for non-emergency situations, increasing the strain on hospitals that are already buried under the high cost of absorbing these patients without compensation. The Medicaid program not only covers basic health care, but also basic programs like adult dental chiropractic and podiatry. Oh no, they won’t after this budget gets adopted.

These may seem disposable and unnecessary on the surface, but the fact is eliminating coverage for them will lead to more severe health problems in the future, again, driving patients to seek care in emergency rooms for pain or infections they can no longer tolerate.

I can’t support the expansion of cost share for Medicaid patients because the people who rely on this program can’t afford health care. Increasing out-of-pocket costs for this population will have the same effect as cutting provider rates and further strain on hospital emergency rooms that have to take patients because they are sick and cannot afford care anywhere else. Remember, for most people Medicaid is a last resort. No one would choose to be on Medicaid if they could afford the benefits offered by private insurance.

I am appalled that we choose to keep taking away from people who already have so little. When times are tough, we can stay positive by focusing on the fact that we still have our health and can stick it out until the storm subsides, but now, even that is in jeopardy. With our unemployment rate up over 14 percent, the need for state services, especially health care, continues to grow. A health crisis in a family already struggling to make ends meet can be devastating and not just financially.

We need to let the people of Michigan know that we care about their health and are ready to step up and make decisions in their best interests. This bill does not reflect that, and I cannot lend my support to the extreme cuts in this bill—something as critical as health care. I hope that the members of this body will oppose this bill. I have only touched on a few of the items that are wrong with this bill, and there are many more. I hope again that members will vote “no.”

 

Senator Brater’s statement is as follows:

Shifting gears now to the Community Health budget, and the issue of the mental health formulary which there was a carve-out for psychotropic medications from the formulary requirement previously, this budget that is before us removes the carve-out. My amendment restores the carve-out.

The reason I am offering this amendment is that there is a very good reason to treat psychotropic medications differently. Medications that treat the brain operate very differently than medications that treat other organs of the body. The consumer who is offered these medications often, as part of his or her illness, is not happy about taking the medication and often there are serious side effects. There are issues of compliance that are different from medications that treat other organs of the body.

That is the reason that this carve-out should remain. Also we are told by the chair of the subcommittee that, oh, it’s okay because if they try these formulary medications and they don’t work, they can go back to another medication, that’s not in the formulary. But I am advised by a psychiatrist that it takes a long time, once you try somebody on a psychotropic medication to wean the person off of it. Then, as I said, once you do this once or twice, the person who is offered the medication may or may not be willing to continue with the protocol.

Now our whole mental health system is based on an out-patient mental health system. We have closed the vast majority of the hospitals to care for people with mental illness in this state. If there is any chance at all that people are going to be able to function in the community, it is essential that they have quick and easy access to the medications that their physician thinks is going to most expeditiously and appropriately help address their symptoms. I strongly urge my colleagues to support this amendment.

 

Senator Cherry’s first statement is as follows:

As you may know, this budget eliminates all but $5 million out of the Healthy Michigan Fund. There are many programs, as you can guess, that are very important that are funded through that line item. Almost all of the prevention dollars in Community Health are funded through the Healthy Michigan Fund: things like cancer prevention and control; cardiovascular health; dental programs; many programs dealing with diabetes and diabetes education; infant mortality; lead poisoning; minority health; the Nurse Family Partnership; physical fitness, nutrition, and health; school health services; and smoking prevention programs are just a few of the programs that are funded through the Healthy Michigan Fund.

This amendment restores all of those cuts because it is important at a time when we are trying to provide health care and save on health care costs. We should also be looking at what does save health care costs. The Healthy Michigan Fund does just that. I know that many of the members here will say there just is no money for this. We have gone through that argument over the last few budgets, and I again say to you that there is more than one side to a ledger. There is the cutting side, but there is also the closing of tax expenditure side. We have not even addressed that side of the budget.

I am hopeful that we will start doing that, and as we recognize that there are other sources of dollars through tax expenditures, this would be an area that we would want to fund. I hope that we can put that priority on prevention programs right now. I ask members to support this amendment.

 

Senator Kahn’s first statement is as follows:

I appreciate the good senator from District No. 22 on the Healthy Michigan Fund, which I share. Our issue, though, is that it does, in fact, include available dollars. How we will be able to balance a budget for the people of Michigan, which programs though distasteful to cut, will have to be cut. Ultimately, that becomes our responsibility; what we signed up for when we let our names be put on a ballot.

The Healthy Michigan Fund, for all the good work it does, is probably really the ultimate earmark. The monies that we have cut from it are not targeted at any particular program, but rather at a combination of reductions and rolling up the line item which would allow the department to decide which programs that they will support. Injustice, it is more than that because the vast bulk of the dollars are reduced from $18 million to $5 million.

There are really three large areas where we can find available dollars to balance this budget. One is in the Healthy Michigan Fund. We need to have this reduction, or we need to be talking about raising taxes. It is that stark. I urge the defeat of this amendment.

 

Senator Cherry’s second statement is as follows:

This amendment is one that restores the community mental health non-Medicaid funding to the Governor’s recommendation, which is already, I think, a cut to community health. So this amendment just decreases the amount of the cut. The reason I have asked for this to be restored is because community mental health services already, because of the continued decrease in community mental health dollars for General Fund dollars, are only pretty much able to serve Medicaid-eligible clients. But, as you can guess, there are many more people in this state who need community mental health services than just Medicaid clients, and it has put quite a burden on our community mental system because they just are not able to serve these people.

The mental health community has taken quite a hit in this budget and at a time when we are releasing prisoners on the street and at a time when people in general need more mental health services because of the stress that they are undergoing. This is not a time to cut General Fund funding for mental health services.

So, because of the state of this state in terms of the economy in terms of what we are trying to do, it seems to me that this would be an area where we would want to make sure that we don’t fray the services that we are providing. It is a safety net. This amendment restores it to level that still isn’t the best that it should be. I ask members again to support this amendment.

 

Senator Kahn’s second statement is as follows:

I rise in opposition to this amendment. It should be noted that the federal rules in regard to cost sharing state that only nominal amounts can be instituted as cost-sharing strategies. Why is that? It is because, of course, we do want people to get care. The notion of co-pays is about making them think a little bit about the level of need. We don’t want the dollars to deflect them from getting needed care, but having people with a simple cold show up to an emergency room is not desirable either. The portion of House Bill No. 4436, the Senate version, that addresses co-pays stays within the framework of the allowed federal nominal values. For that reason, I would urge the rejection of this amendment.

 

Senator Clarke’s statement is as follows:

One of the most important issues we are facing right now is health care. The U.S. Congress and this Legislature are working to find agreement on how we can provide health insurance for many millions of our citizens who don’t have insurance at all. That’s an important objective because many times our people don’t have access to health care because they can’t afford it. They don’t have health insurance.

I’m asking all of you in the Senate to approve this amendment because there is another health care issue that provides a very cruel paradox. We have thousands of citizens in this state who can’t find health care, even though they have health insurance. They have health insurance, but they don’t have access to health care because they are on Medicaid. Before the proposed 8 percent cuts, Medicaid reimbursement rates didn’t nearly cover the cost of providing medical care to patients receiving Medicaid health insurance coverage.

As a result, many hospitals and physicians moved out of areas that had low-income residents, such as our cities and farm areas. I’m asking you to invest $97 million to fully restore the proposed 8 percent cut to Medicaid providers. Where are we going to find the money? I ask you to take part of the General Fund savings created by the additional federal match under the federal recovery act. I know we need to use that to balance the budget, but let’s use a good portion to balance the budget—90 percent we can use to balance the budget. If we just invest 10 percent of the savings that the federal government provides us, we can fully fund the state portion to make sure there is no further cuts to our Medicaid providers.

Some of you might say why should we do this? We can’t afford to even do that. Here is my answer and this is the most important thing—even though the Senate might not be listening, I will speak directly to the people of this state—we cannot afford not to fund this. If we fund this amendment, we will receive three times the amount of money from the federal government. We will receive a three-time match to every dollar that we invest. For nearly $100 million that we invest to provide Medicaid funding to our Medicaid providers, we will receive nearly $300 million. There is an additional $300 million at stake right here that we can only get by voting “yes” to this amendment. I urge you to do so.

 

Senator Kahn’s third statement is as follows:

I rise in opposition to the Clarke amendment. It is $94 million and of that $94 million, half of it, 4 percent, was part of the executive order which we all agreed to. If there is someone, I heard a rumbling that someone maybe didn’t vote for that. If not, I certainly would like to know who.

The methodology by which these funds are subtracted from the budget, this 8 percent cut is able to be made whole completely or in part through the existence of the Quality Assurance Assessment Program. I have had conversations with some of the affected providers—there are three here: physicians, hospitals, and nursing homes—about methodologies to use that program to alleviate some of these cuts, which are indeed severe. I am hopeful that they will be successful.

As we go forward here in constructing a budget, this is the last of the three areas that I identified that are available for us to make reductions to meet our budget targets and address the issue of taxes versus right sizing government. I urge the rejection of this amendment and of the $94 million price tag associated with it.

 

Senator Cherry’s third statement is as follows:

This amendment takes the Medicaid provider rate back to the E.O., which means that providers would get a decrease in their provider rate, which means they will be cut 4 percent—about $47 million, which is about half of what the prior amendment cost. It is a great deal that now maybe the chairman of the Appropriations subcommittee can actually hear, but it is a 4 percent reduction in the Medicaid provider rate. As I said, it costs about $47 million. Even with this, again, we are trying to make sure that, as it was said earlier, Medicaid providers continue to provide care to their patients, and hospitals are still able to operate even though they will have problems with this four percent cut. It is not as onerous as the 8 percent cut.

Even with the amendments that I have, the total of the amendments I have is still $100 million below the Governor’s recommendations. I am trying to cut, too, and recognize that we have a serious problem but also recognize that we have to make sure that health care is provided. I ask that my statement be printed in the Journal and really ask my fellow members to support this because we do need to make sure that Medicaid is provided by our doctors and our hospitals.

 

Senator Kahn’s fourth statement is as follows:

I appreciate the comments here of the Senator of the 26th District, as I did those of the Senator from the 1st District.

It’s the same issue, same cost overrun problem for us, and same arguments for rejection; this time of a $47 million budget buster. I ask the defeat of this amendment in the same way that we defeated the last one. If there should come funds later or through the target-setting process, these things can be re-addressed at that time. All of them that we have talked about.

But as it stands today, the dollars that we have, which are weakening month by month, are nowhere near those that were laid out in any of the budgets, and in particular, this budget in February.

 

Senator Cherry’s fourth statement is as follows:

This amendment concurs with the House funding for aging community services. As you may know, this budget does something that’s good. There is something in this budget that I think is good and that is that it continues to work to transition people from nursing homes into independent care when nursing homes are not the appropriate placement for them. However, even though this budget works on that, it also cuts one of the services that people need when they are trying to live independently in their homes. That is through the community service line item of the office on aging.

So it seems to me that would be something we want to restore. It is not very much money. It’s only $955,000. It provides a great service to people who need to stay in the home and we want to stay in their home because it costs us less money in the long run. I hope, again, that members will support this amendment, although I haven’t got a very good track record this afternoon. This amendment is one that I think people should support.

 

Senator Kahn’s fifth statement is as follows:

I have to smile a little about the modesty of the Senator from the 26th District. I think she’s doing just fine. General Orders, I think, was all about you, young lady. This amendment I have sympathy for, though, I will oppose. As the good Senator knows, my wife works in this community. My wife’s job is jeopardized by this. I, like you, am not here to advocate for just my family, of course, but for all the citizens of Michigan and for a budget that is balanced and responsible. Therefore, with considerable reluctance on this, as I did on the others, I must urge the body to vote “no.” We don’t have the money.

 

Senator Cherry’s fifth statement is as follows:

This amendment strikes some boilerplate language that shifts the MIChild program from Blue Cross Blue Shield to HMOs. Just as a little bit of background information, the MIChild program was implemented to ensure access to vital health, vision, and dental care for children of low-income families. I know that you all know that, but it is important to know that the MIChild covers some very important services like check-ups, shots, emergency care, dental care, pharmaceutical drugs, hospital care, prenatal care and delivery, vision and health, and mental health and substance abuse services.

The change that has been proposed in this DCH budget would transfer the administration from the MIChild program from Blue Cross Blue Shield of Michigan to Medicaid HMOs. You are going to be told that this change is a cost-saving increase. I believe that this change would greatly disrupt coverage and create access issues for Michigan families in a number of ways.

First of all, the Blue Cross Blue Shield of Michigan administers the MIChild program and assumes over $15.5 million in annual cost that it does not bill back to the state. As part of its social mission spending, the Blues have chosen to bear the annual cost of administering this program. Families that opt to enroll in MIChild currently receive a Blue Cross card, and you know how widely recognized that is. They enjoy a network of providers operating in all 83 counties and accepted by more providers than any other carrier in the state. Converting MIChild to a managed care only program would create problems for families in areas, but relatively few Medicaid providers currently exist. Access to quality and comprehensive health care services would be greatly jeopardized.

Providers currently benefit from reimbursement to Blue Cross Blue Shield of Michigan provider rates and not the Medicaid rates as this proposal will adopt. So providers will get less reimbursement. Families in many areas of the state are already struggling to locate doctors who will accept Medicaid, and I fear that more providers will then decide not to take MIChild clients. Those providers who accept Medicaid must accept lower Medicaid reimbursement rates as payment in full, and we just talked about how we even lowered those rates more.

Many providers are opting out to no longer participate in the Medicaid program because rates are not keeping pace with inflation with the actually cost of care. I believe if this change is adopted, many of them would not participate in the program, leaving families with decreased access to health care coverage. Approximately 28,000 of the state’s 32,000 MIChild enrollees are currently covered under a Blue Cross Blue Shield of Michigan card.

The hospital and provider network under Blue Cross is large and includes all general hospitals and a comprehensive list of health care providers in Michigan. A change to a managed care arrangement would create a disruption in coverage for the 28,000 children currently covered under Blue Cross who would be forced to try and secure coverage with the Medicaid managed care provider. It is one of those programs that is a difficult population to enroll, and to convert those kids to a Medicaid provider would just cause so much disruption that it won’t be worth any savings, if we get any savings at all because of this program.

I hope members would adopt this amendment. Reject the transfer of Blue Cross to HMOs for the MIChild program.

 

Senator Kahn’s sixth statement is as follows:

I rise in opposition to this amendment. Our HMO networks across the state of Michigan are superb. We have four HMOs in Michigan that are in the top 25 in the entire nation, tow in the top ten. I don’t think there is really a question of degradation of care here. I think that on reflection, I would hope that the good Senator would agree with me that our HMOs are fine.

Really, the issue here is one of the funding. By making this transfer, patients, children may be reconnected with the rest of their family in the same HMO. That is probably the case, not just maybe the case. But in particular, because of the Medicaid matching rates that were brought up before as part of the issue in the cuts to providers, the state will see about another $2 million worth of income. It is an interesting number. That is about the same as the dollars we will be using to fund the MICR.

I urge the rejection of this amendment as a cost-savings measure for the people of Michigan and as a reuniter in an excellent HMO network community across our state.

 

Senator Kahn’s seventh statement is as follows:

Indeed, it is true that the good Senator from the 26th District and I have discussed modifying this particular amendment, but we did not come up with the language that would allow us to do that. The notion of having a bid process is very sound, of course. Whether or not this amendment, as currently constructed, is going to be the ultimate expression of that process is uncertain. But since there is nothing like this in the House bill, we cannot remove this, or we will not have a point for discussion between the Senator from the 26th District and me. I urge the retention of this boilerplate and the rejection of her amendment, and the process will move forward.

Senator Cherry’s sixth statement is as follows:

This amendment deals with a program we provide in Michigan. It has both state and federal funding, and it is what is called the Michigan Essential Health Provider Program.” What it does is for medical professionals, doctors, nurses, and any medical professional who are going to school and get a loan, this program helps repay the loan if providers work in underserved areas. It seems, if we are trying again to lower costs of medical care, that this would be something we would want to do. We have a shortage of many medical professional in this state, especially in cities, urban settings, and rural settings. I really don’t understand why we are being short-sighted and cutting this program. I hope that members do support it, that we make sure that do have physicians, nurses, and medical professionals in underserved areas. This amendment does that.

Senator Kahn’s eighth statement is as follows:

I rise in opposition to this amendment. It is a worthy program. I went to school on loans myself. It would be great if there was the money available for this and also for the nursing programs that we addressed earlier today in terms of being able to provide funding and support for them. There are loan dollars available and would be an appropriate substitute for an individual seeking support to go through school to find that support through the loan programs.

So for the same reason that we have discussed the preceding nine amendments—dollars and our lack thereof—I urge the defeat of this amendment as well.

Senator Kahn’s ninth statement is as follows:

I greatly appreciate working with Senator Cherry on this budget. She is thoughtful, and her concerns here are also thoughtful. In the same sense, in Genesee County, which has an excellent medical community, they found that the most efficient way to deliver care is to coordinate it. It is true across the rest of the state. Taking substance abuse and artificially separating it from mental health is a mistake.

The number of people who have substance abuse problems who don’t have mental health issues is pretty small. Folding these two departments together saves us $1 million; gets rid of one level of administration; allows for coordinating care; and improves the delivery of that care to our people. It is for those reasons that they fixed the problem in Genesee and in many of our counties across Michigan. Coordinating agencies are apart of their community mental health organizations and PIHPs. This should be encouraged, and this existing language does that. I urge the rejection of this amendment.

 

Senator Scott’s first statement is as follows:

Amendment No. 12 would roll together all the CMH non-Medicaid funding lines and would restore funding to the Governor’s recommendation of $320 million or $54 million over the level currently in this bill. Amendment No. 13 is related and would restore the current year allocation formula for CMH non-Medicaid funding.

Current year allocations for CMH non-Medicaid funding are based on a distribution formula that has been in place for many years. This budget would change that formula in a way that I feel is grossly unfair. The new formula is perpetrated to be more equitable. However, just because of the formula change, Wayne County mental health services would lose $25 million or about 23 percent of their funding. This is on top of the $18 million they will lose as a result of the across-the-board cut to all CMHs. Detroit-Wayne would stand to lose a total of about $43 million or about 40 percent of their funding under this current budget.

How can we say this is equitable in any way? I know the department and many of the 40-plus other CMH agencies will argue that the new formula distributes money where it is needed. But, intuitively, we know that Detroit and Wayne County have the largest population of persons who need these services.

Wayne County has served a larger number of persons over the last several years than any other agency. Everyone should share in the pain of these difficult budgets. But to cut one agency by over 40 percent is outrageous. My two amendments would roll together the line item for CMH, restore funding to the Governor’s recommendation, and would maintain the current year funding allocation.

We must all keep in mind that we talked about it in another budget—the Corrections budget—that about 4,000 prisoners are coming out. These prisoners are being processed right now in my district, Mound and Ryan. The majority will be coming to Wayne County. We know that there are so many who have been incarcerated with mental health issues and so many who were incarcerated became mentally ill just being in prison. But these people will be coming out not because they are coming out earlier, but they have done their time and are being released. We need to make sure that we have the proper funding available when they come into the communities.

I would hope that you would think about this, and let’s do something about this one.

 

Senator Kahn’s tenth statement is as follows:

I thank, as well, the good Senator from the 2nd District with her unfailing charm. Let me address the first of these two. The first is the amendment labeled No. 12. We addressed that earlier in the amount of money that will be available through the CMH non-Medicaid line currently funded at $322 million and at that number before the roof or the basement or the sides of the building fell out in our budget house. That led of course to the reductions that you see.

I think, really, that the area that is new is Amendment No. 13 in the funding formula. Let me address that. The CMH non-Medicaid funding formula was the result of convening the mental health community in 1998, and that was the first time it was done. A funding formula to decide what was an equitable distribution of funds was created. What is a equitable distribution of funds? Equity was defined largely by a different word—”need.” Then, of course, you have the issue of what is need? Need became defined by proxies—things that would demonstrate that there was, in fact, some need. What were the proxies? Things like school lunch programs, crime rates in a community, and poverty. Those became the basis for that formula. It was applied that year. The following year, there were some concerns about it, and it was applied in another formula that was put together in 1999 or perhaps 2000.

Those formulas got into hot water because, like all formulas, they apply to all of us and not to just a certain segment of the population. There was no formula available until last year. When a community mental health organization got into some trouble, the mental health director would reach into his pocket or look into his budget, as it were, and find $1 million here or $1 million there to straighten out the scrape that the community mental health agency was in.

In a way to get beyond that kind of funding mechanism, a new round of meetings were held. Every CMH in the state was invited and a new formula was developed through their meetings. I had nothing to do with it. A new formula on equity was applied in the cuts that were part of the executive order last year. It is now part of how the department plans to fund next year. As such, it is deserving of the respect that its creation implies. Everybody was involved. Yes, there are some losers, but it is equitable. I urge the defeat of Amendment No. 13, as well as No. 12

 

Senator Scott’s second statement is as follows:

If there was ever anything that was truly, truly important in this budget, it is this amendment that I have. The Senator from the 18th District said most of what I wanted to say. The chair of the committee mentioned that it was equitable and that the CMHs had voted on this. Well, when you get an opportunity—and if Wayne County only got one vote out of that, of course, if they could take the dollars away for their community, they would do that. But I don’t think anyone realizes that there would be 4,000 inmates who are going to be released, and the majority of them in Wayne County—they even chose Wayne County—for all of these prisoners to be processed. I would hope that now that we know that they are coming out, we don’t have all of the dollars that are necessary, or at least we are not putting all the dollars in for these prisoners to come out. They are coming out so I think we need to have a change of heart and realize that it is going be very devastating if we don’t make some change in this formula.

I would ask that we would accept both of these amendments, and then later we can think about how we are going to do this. But at this time, we know it is truly important that we don’t use this new formula. It is disastrous, and it is on us because it is up to us to make a difference in this.

 

Senator Kahn’s eleventh statement is as follows:

I appreciate the continuing passion of the Senator from the 23rd District on this issue. I didn’t have a chance to see this prior to today, but that probably, all in all, isn’t critical because, clearly, this is an area where we are contending between the parties now, and it really doesn’t belong in the budget bill. It belongs in debate before this floor in consideration of where we are going to go on this issue at a later time. I urge, therefore, its rejection.

 

Senator Whitmer’s statement is as follows:

Yesterday, I noticed that a number of members offered amendments to the higher education and community colleges budgets that went something like this, “If additional funding becomes available, the Legislature would like it to go to promise zones,” which is what the Senator from the 13th District said; or Michigan tuition grant, which is what the Senator from the 32nd District said; or renaissance zones, which is what the Senator from the 33rd District said. Truth be told, I was kind of surprised. What does it mean “if funding becomes available?” These were amendments offered by the same people who wrote the budget bills, after all, that slashed those very programs. So they were amorphous, feel-good amendments, I guess.

Well, that inspired me, not to do the same, but to look to save something I care about in these budgets with a very real, possible, measurable contingency. So here it is. My amendment provides that should we, the Legislature, repeal our one-in-the nation drug immunity law—the same law that precludes our citizens victimized by a dangerous pharmaceutical drug from recovery—if we decide to stop treating our people as second-class citizens and give our people the protections people in the other 49 states enjoy, then any dollars that the DCH recovers in their capacity as a third-party intervener under current law and in that capacity negotiates to recover Medicaid losses, those dollars—estimated based on others states’ recovery for the same to be in the realm of $30 - $80 million—those dollars would be used for the Medicaid adult dental services, school-based health centers, and expand the Healthy Kids dental program statewide to all 83 counties to kids in every one of our counties.

Talk about the proverbial win-win. We could right the wrongs we have perpetrated on Michigan pharmaceutical victims and shore up the safety net obliterated by this budget bill if we adopt this amendment and change the drug immunity law. I ask for your support.

 

Senator Gleason’s first statement is as follows:

We have been discussing funding priorities here for most of the day. I think one of our greatest obligations is to make sure that we offer health care to the uninsured, particularly those who would like to have the insurance. Over the past few years, it has been discussed that many Michigan citizens do not prefer the insurance coverage. For those who lose their jobs today, and we know there is too many of them, they have an opportunity to purchase COBRA.

There are a lot of things I would like to purchase too, but I can’t afford them. COBRA falls into that wish list, except that is not only a wish, but it is a need for many families. What my amendment does is ask that we make COBRA somewhat more affordable for families here in Michigan, those who are uninsured and would like to have it. I have a simple request—I think it is a benevolent request—to put back $5 million into the COBRA fund, so that we have it subsidized for the families that don’t have it.

Far too often, we have talked about preventative care rather than accumulative crisis care. If we offer these families and potential carriers of COBRA a chance to have affordable health care, maybe they can get in sooner to prevent some of the long-term ramifications that we lose by not having early detection, whether it is high blood pressure, sugar diabetes, or other health concerns.

I ask that we consider this and support it to make health insurance more affordable. It is $5 million, and I think we can help many people who would request it. I am here speaking for those who would like to have COBRA but can’t afford it. I think we have the ability today to make that much-needed insurance affordable.

Senator Kahn’s twelfth statement is as follows:

 

Senator Kahn’s twelfth statement is as follows:

I rise in opposition to this amendment. Like the amendment prior, it was first seen by me today. It avows some considerable policy issues, as well as some funding issues, where the money is coming from and how county-shared plans and third-share plans would lose $5 million here, if I read this correctly. It is brand new for me to read.

How it will all be dealt with is also unclear, and therefore I oppose this amendment. I ask for its defeat.

Senator Hardiman’s statement is as follows:

This amendment is a very simple one. It simply adds a $100 placeholder for coordinating information between the LEIN system and the new Bridges DHS system. Obviously, this affects the community health in that the DHS staff do eligibility for Medicaid. This continues the policy from the current fiscal year. It is important to ensure assistance payments only go to those who are entitled to them, especially in this very difficult time of budget cutting. I ask the body’s approval of the amendment.

Senator Kahn’s thirteenth statement is as follows:

I would like to thank Dr. George for his comments. Among the concerns which have been raised in changing the preferred drug list are about safety for our patients, efficacy for our patients, the behavior or potential behavior of the department, and on your desk to address that I gave you a one-pager.

I would like to talk about addressing prescriber concerns and consumer concerns. When a prescriber requests a non-preferred drug, he or she must attain prior authorization; therein is the rub. A step-added process is what it is called. It can be employed upon the recommendation of the pharmacy and therapeutics committee and allow prescriptions for certain non-preferred drugs to proceed without the need for prior authorization if a preferred drug has been previously prescribed. You don’t have to have prior authorization if you are already on it.

The prior authorization process has become more sophisticated and streamlined, and a prescribing doctor who needs to use it can use toll-free telephone lines, toll-free fax lines, and a secured Internet-based web for prior authorization. It can be accessed 24 hours a day, 7 days a week. There is even capacity to bypass the need for prior authorization by simply writing a diagnosis code on the prescription; simply write a diagnosis, no prior authorization.

Addressing consumer concerns, all individuals currently using a psychotropic drug identified as non-preferred by the pharmacy and therapeutics committee will continue to receive their existing prescriptions without prior authorization.

The Michigan Department of Community Health will communicate extensively with consumers, clinicians, advocates, and the pharmacy communities during all phases of the implementation process to ensure many opportunities for input are provided. The goal is to ensure that the best and most appropriate psychotropic medications remain available and accessible to the people we serve.

In my office, I had multiple meetings with folks who are lobbyists for the pharmaceutical community. They brought me papers, medical papers, many of the. I don’t know maybe eight, nine, ten on up. In the bulk of the papers brought to me, they had little carve-out sections—talking about a carve-out—where they mention what would be a good preferred drug list and how it could work. I sent these to the Department of Community Health. Michigan is doing these things already.

I leave you with this last restatement. What the department currently has contains even the capacity to bypass the need for prior authorization by a physician by simply writing a diagnosis code on the prescription.

 

Senator Switalski’s statement is as follows:

I appreciate the dedication and diligence that Senator Brater brings to the job and her tireless advocacy for the mentally ill. I also appreciate the comments from my good colleague, Senator Olshove. But I think the problem that he lays out is changed in this legislation. It is not the same as it was some years ago to the point where if you are on a type of psychotropic drug, you would be allowed to continue that. So that is a significant change from what it was in the past, and I think it would deal with the situation he is describing.

Reluctantly, I am going to vote “no” on this amendment. I believe discussion on this policy change must go forward. This is not a partisan issue. The EO eliminated this carve-out, and it was supported by both parties. The Governor’s budget also eliminated this carve-out. The House disagrees with us and wishes to maintain the status quo, but I believe this issue should advance to the conference table and so a point of difference is justified. If we have this and the House doesn’t have this, this can be settled at the conference table. Defeat of this amendment would allow this to go forward to the conference committee.

Only in the context of making actual choices can we come up with good policy. The actual choices are we do have to cut $7.5 million. If we don’t cut it on this item, we’ll be cutting it on some other item. It’s best that we make a choice between alternatives. I believe that everything should be on the table, therefore, I am going to vote against this amendment.

 

Senator Olshove’s statement is as follows:

I do believe there are many people in this chamber; in fact, the good doctors who may be speaking from a practice that they haven’t been at. I have experienced the situation that we are talking about. I think if you recall, it was four and a half years ago I came back to this microphone after going through a very tough time. I’ve gone through that time over and over again over the last few years. I wouldn’t wish that on anybody.

To change this is putting many people in jeopardy—people with epilepsy, people who can actually hurt people on the road—should they not be able to take the proper medication that they have attained a balance with. It is very tough to establish a balance. If that is jeopardized, or if some board with some doctors come and tell you that you are not entitled to that drug or it’s not on our list anymore or if I have to fight for that drug to reestablish some balance, to establish some safety on the road, I think it is unconscionable that this body would approve that.

I would appreciate your “yes” vote on the Brater amendment please.

 

Senator Cherry’s seventh statement is as follows:

I only want to add my words to support of this amendment. I also have had experience personally with family members, and I know how important it is to have a good balance of medication. I don’t care what we talk about in terms of what we think will happen. There is a problem with changing this. I hope that members will continue to vote for the Brater amendment.

 

Senator Gleason’s second statement is as follows:

I believe we made a lot of tough decisions today which we didn’t necessarily have to make. I think we are about to do that again right now. People are saying that we must cut, but do we really have to? Now there has been an option which has been presented to us a few weeks ago saying that maybe we don’t have to make all of these cuts; that maybe we do have a funding stream which we haven’t yet had the courage enough to address.

Pretty much most of today, we have put our citizens at greater risk, and in many cases, harm’s way by cutting these budgets. But why don’t we take the responsible step and put our sick, ailing, and invalid citizens ahead of certain tax credits? Why don’t we look at an approach about funding some of these ailments instead of always cutting? Why do we cut things which are vital to our families?

About an hour and a half ago, it was said, well, this is what we signed up for. I didn’t sign up to cut any sick persons’ benefits. That’s not what I signed up for, but we’ve been doing that pretty much most of today. So I think it’s high time we take a serious look when we’re giving special treatments to special interests over sick people.

Let’s take a responsible look at tax credits. I’m one who says let’s put them all on the table, those which may be favorable to the Democrats and those which may be favorable to the Republicans. But let’s quit putting special interests above sick Michiganians. We’ve done that for too long. The constant remarks in regard to the amendments today trying to stand up and afford some sense of relief for our sick constituents in everyone’s district in all parts of the state should be met with an equal, maybe a higher, responsibility—look at tax credits. Why give special treatment, special breaks, and funding opportunities to special interests over sick and dying Michiganians?

We can do better than this. There’s not a single person in this room who would stand by if they had a sick child or a dying parent to say that we can’t find a purpose in setting aside some tax credits for funding the sick and the ailing. So let’s look at this closer. We can do better than this and we should.

 

Senator Kahn’s fourteenth statement is as follows:

With great reluctance, I rise to oppose this amendment. The amendment is not well written. It says, “(i) The department shall comply with and reimburse a prescription containing a doctor’s dispense as written order for all behavioral health patient prescriptions.” That would include high blood pressure pills, heart pills, diabetes medications, and on and on.

As part of the discussion that we have had on this entire subject today, there is a message and that is to get it right and get some protections in. There isn’t a message that we want to back away from everything we have ever done and every other part of the dispense as written versus prior authorization P&T committee actions.

So this amendment, I understand why it is here, but it is poorly written or unfortunately written—is a nicer way to say it. I would look forward to working with Senator Brater to give some of the protections she would like as we go through the process of policy bills and bills in Appropriations.

Senator Cherry’s eighth statement is as follows:

I hope that the good chairman of the subcommittee would reconsider his opposition to this amendment. The words “behavioral health” are an accepted term of art which refers to medication for brain disorders. It’s pretty clear that what we’re talking about is specifically the issue of psychotropic drugs. I believe that these are all verbal assurances that have been given to us through subcommittee meetings and from department discussions. It seems to me it makes sense to put them in writing in boilerplate in the bill so that we’re very clear about this policy.

I hope, I hope that the chairperson of this committee would reconsider his opposition to this amendment and place this language into the bill. As we’ve heard from members, there’s experience regarding this issue from a wide variety of perspectives within the membership of this body. I think it’s only fair to have some language to reassure us that what we are doing does not jeopardize the mental health of any citizen of this state. I ask that the chair reconsider his opposition and all of us vote in favor of this amendment.

Senator Kahn’s fifteenth statement is as follows:

In concluding remarks before we vote here, I’d like to thank Senator Cherry for her passion and for the things that we could work on together and advocate for together; Senator Pappageorge, the majority vice chair, for his work; and all the committee members: Senator Barcia, Senator Switalski, Senator George, and Senator Stamas.

This budget, as proposed, as Senator Cherry points out, has weaknesses. Those weaknesses are a reflection of the weaknesses in our economy. They are not weaknesses in caring or wanting, as Senator Cherry so well points out.

But there are some good things in this budget. Let’s close with some of the positives. There’s restoration of the CMH multicultural line item, which funds folks in southeast Michigan in particular, but actually all across the state, who are in need. Some small clinics have been restored. Early childhood collaborative secondary prevention and nurse family partnerships were restored. A priority in this budget was staked out for children—for children. We found in the adult home-help community that the folks who work there are just dramatically under-supported and that’s helped too. We improve the institutional memory, the ongoing retention of employees and, therefore, the quality of care that is delivered by these folks. We even found a way to move towards a new idea for Healthy Kids dental, adding it to Sterling Heights, Macomb County, and Highland Park in Wayne County—both communities with children in need.

As we move on, hopefully, to pass this budget and then to the conference committee, you can defend the notion that this budget with its cuts defended children. I ask for its passage.

It seems to me that everytime there's a vote to take spending away from an appropriation,it's always the helpless individual that suffers the consequences,with out even realizing that it happens to them!!