Rep. Carrie Rheingans (D-Ann Arbor) has introduced a bill that would create a publicly funded health system that would provide comprehensive services in Michigan.
House Bill 4893 would establish a universal healthcare system and reform the current payment system for healthcare coverage in Michigan. It would utilize both private and public providers to offer physical, dental, and mental healthcare without deductibles, copays, or premiums.
Several states have proposed single-payer healthcare systems but have found it challenging to devise ways to fund it. Washington and Oregon are both currently considering options to finance single-payer systems. Washington’s Universal Health Care Commission has been working on that since it was formed in 2021, and Oregon lawmakers voted to create the Universal Health Plan Governance Board this year to do the same.
Rheingans told State of Reform she is still considering options to fund her proposal for Michigan, but plans to utilize MICare, which all residents would be eligible for. It would include coverage provided under Medicaid, Medicare, MIChild (the state’s child health plan under Title XXI of the Social Security Act), employers that choose to participate, and state and government employees.
“The trust fund would have money going into it from a variety of sources,” Rheingans said. “We’re hoping the federal administration will approve a Medicaid waiver to allow Medicaid funding to be used.”
MICare would attempt to obtain federal funding as well.
“A big chunk of money from the feds would go into the fund. We expect employers to pay a tax. Taxes would go into the trust fund. We propose that it be a graduated tax, so smaller businesses would not pay as big a share as big businesses. Our state only allows for flat taxes, so in order for this to be possible, we would need to change the (state’s) Constitution. That’s possible, we’ve done it recently.”
— Rheingans
Rheingans plans to set reimbursement rates at 125 percent of the current Medicare rate.
“It’s a higher level of reimbursement than Medicare that we’re working on,” she said.
Rheingans has vast experience working in healthcare, and is the only legislator in Michigan with a master’s degree in public health. She has worked for the Center for Health and Research Transformation (CHRT), the Michigan Public Health Institute, and serves on the Washtenaw County Board of Health and the Washtenaw Emergency Medical Services Commission. And she believes a universal healthcare system is achievable.
“I worked at the CHRT during the rollout of the (Affordable Care Act), on a social service group that was trying to get access to care for low-income individuals, was a health policy expert, and really got a good understanding of how health financing works during that time,” she said. “We’ve got a good coalition forming. I am very interested in this topic, and I think it’s possible if puzzle pieces fall where they need to.”
Rheingans is working to get the word out about HB 4893, most recently hosting a town hall meeting with US Rep. Debbie Dingell (D-Michigan).
“I’ve had one town hall in my district with Dingell, and she is a co-sponsor of a Medicare for All (bill) at the federal level. It was in the Ann Arbor area so there was a lot of academia there asking great questions. My district is a champion for single-payer. We have another one in September, and will probably have around five across the state by the end of this term.”
— Rheingans
HB 4893 includes the formation of a board that would oversee the MICare trust fund. If the bill is approved, the board would work together to roll out implementation of its provisions.
“In the bill, we say that in one year, employers of a certain size will have to have the tax start,” Rheingans said. “We think there needs to be an implementation timeline of a couple years. We also need to have the fund full of money before we start. We could use a bond.”
The initiative will also require significant educational efforts while it is rolled out, Rheingans said.
“The trust fund and the board will need to hire hundreds of people, maybe thousands,” she said. “And theoretically, this reduces the contracting burden for providers, so there will be staff that (have done) that kind of (work) that could come and work for us in the trust. We do have a lot of support. We have 22 co-sponsors and there are quite a few folks who support it but couldn’t co-sponsor. We’re looking for good feedback to use so we can make the bill better. I am trying to reach out to (universal healthcare) bill sponsors in other states.”