Updates About Health Policy

The Michigan Senate has passed a package of bills that would create a state-based healthcare exchange in Michigan. Similar legislation was also passed by the Senate last session. If passed, Michigan would move away from the federal healthcare exchange to a newly created exchange run by the state by January 2028.

SB 973 would create the Michigan Health Insurance Exchange and outlines the creation of a 12-member governing board, which would create and oversee a non-profit corporation that provides the health plan marketplace. It also outlines governance, oversight, funding, reporting, and enrollment requirements for the exchange, while requiring the Department of Insurance and Financial Services (DIFS) to certify the qualified health plans according to State and Federal law and the provisions of the legislation.

SB 974updates insurance code definitions to align with the state-based health insurance exchange created under SB 973.

SB 975 requires DIFS to contract with the state-based exchange to certify qualified health and dental plans.

SB 976 would require insurers to provide enrollment information required by the state-based exchange.

SB 977 requires DIFS to apply for a federal waiver to create a state-based reinsurance program and report funding needs to the Legislature’s appropriations committees.

SB 978 repeals a law requiring certain health insurance plans to cover specific emergency and early prescription refills.

Each bill passed along party lines (20-16). The bills need to be passed by the Republican controlled House and signed into law by the Governor before the current session ends in December or would need to be reintroduced again next session.

The House Oversight Committee heard testimony on Michigan’s Rx Kids program, which provides direct cash assistance to pregnant women and new mothers in participating eligible Michigan communities.

Under the program, participants receive a one-time prenatal payment of $1,500 and monthly payments of $500 for the first six or more months following the birth of a child. The program receives funding through Temporary Assistance for Needy Families (TANF) dollars, the Healthy Michigan Fund, and private philanthropic contributions.

Throughout her testimony, Rx Kids Director Dr. Mona Hanna outlined the program’s identity verification, residency and pregnancy documentation requirements, fraud detection measures, and birth certificate verification that occur before funds are issued. She also testified that roughly 85% of the program’s funding goes directly to the participants, and the remaining 15% is used for operating and administrative costs. Dr. Hanna cited research that shows the program has led to improvements in prenatal care utilization, reductions in premature births, low-birth-weight births, and neonatal intensive care admissions among participants.

Republican members of the committee raised questions around the sustainability, oversight, and funding of the program as well as the long-term goals and eligibility requirements. Another point of concern House Republicans addressed was the lack of safeguards to ensure funds are strictly used for child and family-related expenses.

Hanna responded that the program is designed as an unrestricted cash assistance model and does not monitor individual purchases, instead placing the trust in the recipient. She also stated that taxpayer funds are not used to provide benefits to undocumented immigrants, but that private philanthropic dollars may be allocated for these families.

Discussions surrounding the program and its funding are expected to continue.

The Senate Finance, Insurance and Consumer Protection Committee recently took up testimony on SB 914, introduced by Stephanie Chang (D-Detroit). The bill would require prescription drug co-pay assistance to count toward a patient’s deductible and out-of-pocket maximum.

Supporters of the bill include patient advocacy groups that represent individuals with serious conditions such as cancer, blood disorders, epilepsy, and other diseases that require patients to rely on costly medications. Supporting organizations argue that the bill would reduce unexpected out-of-pocket costs for patients, while simultaneously improving affordability and transparency in drug pricing.

Opposition comes primarily from insurers and health plans, who argue the policy would influence patients to purchase more expensive brand name medications versus cheaper generic options. It has also been suggested that co-pay coupons increase the cost of brand name medications over time.

The bill is now waiting on a Committee vote.