Rep. Mary Whiteford (R-Allegan) serves as the chair of the House Appropriations Subcommittee on Health and Human Services and vice-chair of the full Appropriations Committee. She also sits as a member of the House Health Policy Committee.
In this Q&A, Whiteford talks about her behavioral health and physical health integration package, her plans for the upcoming session, and conversations happening in health policy throughout the legislature.
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Patrick Jones: Since the legislature has been back from summer break, can you run down what have been some of the main health care conversations within the House Health Policy Committee that you sit on? What is the most important thing in this moment in terms of health care policy in the legislature?
Rep. Mary Whiteford: “One bill — which I am the sponsor of — includes the posting of a non-opioid directive on websites and requiring that for health insurance. So, the genesis from this is that we do have an opioid epidemic. I know from personal experience and as a nurse that oftentimes, if somebody has surgery, just extraction, or dental work, that person will just be sent home with a vial of opiates.
I talked to somebody today [who] had a knee replacement, and he told me how he was on opiates for six weeks. I said that’s unacceptable. He said, ‘But I was in pain,’ and I said there’s other ways to do it. A person needs to have a conversation with their doctor to determine how long [they] need opiates, what other modalities are there, and starting those conversations early so that the person has a conscious decision about whether or not they want to incorporate opiates into their treatment. That’s one package and I’m a part of that was voted out of committee [on Thursday, which includes] HB 5261, 5262, and 5263.”
PJ: What are the most important health conversations happening in your caucus and in the House Health Policy Committee? What are you all actively working towards?
MW: “We also have an issue about psychologists in having interjurisdictional compacts. So that would [entail] that a psychologist can go and have the ability to practice in other states that are part of that compact as well. I’ve sponsored the nursing compact, joining 33 other states in the country to be able to be a part of that. What’s key about this is, in my case — and it came up today with a psychologist as well — , this governor will not sign any type of compact, and it stems from the nursing compact that our unions oppose. So, 10,000 out of 170,000 nurses are affecting everybody.
Another thing is that it comes down to health insurance. We have some bills that put into law — potentially — some boilerplate that I’ve had in my budget every year, and that means that certain medications should not have to go through the pre-authorization process. That’s important because we talked about children or people who have epilepsy or psychiatric drugs — [which] are working — and then a health plan to go and say, ‘Whoops, I’m not paying for that. You have to have a different one that we believe is less expensive.’ It does affect a person’s treatment. So, through boiler plate every year, we’ve been having seven classes of drugs that cannot have pre-authorization, and this bill will put that into statute permanently.
I have a really big bill. [It is] the behavioral health bills of one in the Senate and then mine in the house. [My plan is] completely different [from the] Senate plan which puts everything into health plans while mine removes hundreds of pages of health plan laws that our organizations have to fulfill. Mine streamlines the process so that it strengthens our locals and our communities and their ability to serve disabled individuals with their mental illness. I’m working on a substitute right now and starting work in a month after having thousands of conversations. I went to a listening tour throughout the state to get feedback on this package.”
PJ: Can you tell me more about this behavioral health and physical health integration package and what your plan is for its future?
MW: “This is a $3.5 billion line item [that emphasizes] community support of individuals with these disorders. The Senate plan wants to have health plans manage [the community support for those with behavioral health disorders]. This includes somebody like my uncle, who lives in a group home because he’s unable to take care of himself. He’s developmentally disabled.
Mine maintains the current system of community mental health services, neighbors taking care of neighbors, not getting anybody else in the middle, and then streamline reimbursement straight from the state.
After listening to advocates and speaking for people who have no voice, we’re coming up with a really good compromise. But for now, I am just keeping it real internal, but in December when we come back, I’m getting that to [the committee].
PJ: Shirky’s plan seems to be moving in the legislature. What do you think is different about that plan, and what will your plan better address?
MW: “What I found when we compare apples to apples to other states, when you streamline the process and make it so that the money follows the person and not the system, there’s a savings of $100 to $300 million. All that money can actually be used for expansion of services, and to service mild to moderate individuals. The Senate plan keeps everything as managed care. I think that this population does not lend itself to manage care, because they are in such high need.
So, mine streamlines and makes it so that I don’t have a health plan coming in profiting off of this population. If there’s $100 to $300 million of potential savings, well then that would be money that would be made by a private health plan.”
PJ: Can you tell me a little bit about your learning tours about the behavioral health integration package and what you have learned from hearing from Michiganders?
MW: “We’re such a varied state, so how do I have a bill package that allows the flexibility for such varied populations? It was incredibly helpful. As we talk about different issues and ways to make it better, I could say well, ‘I’ve been Traverse City, they do it this way over in Detroit, they do it this way.’ How can we make sure that we’re addressing that?
That’s why I think it’s so important that we leave the flexibility and empower our local communities to serve their neighbors instead of doing a cookie-cutter approach. That’s where I learned the most so that I can make sure that this bill reflects the ability to have that flexibility, but make sure that we’re prioritizing people.
The Shirkey plan puts everybody into a conglomerate. This is person-centered care, not based on a system. That’s why my plan is a stark difference to our current system and it’s a stark difference from the Senate plan.”
PJ: So I’d like to shift gears a little bit to the 15-bill, bipartisan health care package. What are some of the conversations happening around that package?
MW: “I was fortunate to have the nurse anesthetists law signed. That was 20 years in the making. The rest of it is being highly negotiated between the House and the Senate, and we have until the end of next year. So, [we have] one full term to try to come up with agreements and try to make sure that we have the best product possible going up to the speaker and the Senate Majority Leader.”
PJ: What are your biggest priorities for the rest of the session?
MW: “I’m the Chair of the Health and Human Services budget. This current [year] is about $31.5 billion dollars. We also have federal money. For me, I look at all that federal money coming in, as not in the bank, that we’re actually borrowing from our great-grandchildren. I want to make sure that any decision on how to spend and appropriate that money has that future perspective.
There’s not a lot of people who are really putting their heart and soul into health care and behavioral health. We really need a new Children’s Psychiatric Hospital owned by the state. I think that would be a perfect use of money because crisis stabilization units and psychiatric residential treatment facilities are privately owned. I want to see some type of partnership between the locals or the company that owns it to be able to do this. I want everybody to have skin in the game. I’d like to see a lot of community buy-in for these projects and pediatric psychiatric beds around the state.
I also have a really good bill which really addresses foster kids. Every single one of those foster kids is traumatized. So, the behavioral health needs are very important to me. My behavioral health work as well as my work [as chair of the] foster care taskforce can really move side by side.”
This interview was edited for clarity and length.