Bills Would End Burdensome Co-Pays, Codify Anti-Provider Discrimination Provisions in Michigan Law
On Thursday, September 26, 2024, four MAC-promoted, pro-chiropractic bills, were introduced in the Michigan House of Representatives. The bills are aimed at accomplishing two major objectives:
- Ending burdensome co-pays by capping them at 50% of the cost of the service itself (House Bills 5971, 5972, and 5973).
- Codifying the provider non-discrimination language of Section 2706(a) of the Affordable Care Act in Michigan law (House Bill 5956).
House Bills 5971, 5972, and 5973: Ending Burdensome Co-Pays
The bills would cap co-pays to 50% of the cost of the procedure. How many times have you had a patient whose co-pay is as much as, or even more than, the cost of the service itself? This allows insurance companies to claim they offer a benefit, while in fact your patient shoulders the entire cost. This is “phantom” coverage, and it must stop.
House Bill 5971 (text), introduced by state Rep. Julie Rogers (D-Kalamazoo) (pictured), states:
An insurer that delivers, issues for delivery, or renews in this state a health insurance policy shall not include a health care service as a covered health care benefit under the terms and conditions of the health insurance policy or in any other communication concerning the health insurance policy if the copayment or coinsurance for the health care service payable by the insured or enrollee is greater than 50% of the cost of the health care service.
House Bill 5972 (text), introduced by state Rep. Felicia Brabec (D-Pittsfield Township), states:
A third party administrator shall not enter into a service contract for a benefit plan if the benefit plan includes a health care service as a covered health care benefit and the copayment or coinsurance for the health care service payable by the covered individual is greater than 50% of the cost of the health care service.
House Bill 5973 (text), introduced by state Rep. Mike McFall (D-Hazel Park), Majority Vice Chair of the House Insurance and Financial Services Committee, states:
An insurer that delivers, issues for delivery, or renews in this state a health insurance policy shall not include a health care service as a covered health care benefit under the terms and conditions of the health insurance policy if the copayment or coinsurance for the health care service payable by the insured or enrollee is greater than 50% of the cost of the health care service.
The bills also direct the Director of the Michigan Department of Insurance and Financial Services (DIFS) to investigate and issue a ruling on all complaints arising under the bills.
The bills were assigned to the House Insurance and Financial Services Committee. The co-sponsors of HBs 5971, 5972, and 5973 (in alphabetical order after the main bill sponsors) are below. Members of the Insurance and Financial Services Committee are in italics.
- Julie Rogers (D-Kalamazoo), Main Sponsor, HB 5971
- Rep Felicia Brabec (D-Pittsfield Twp), Main Sponsor, HB 5972
- Mike McFall (D-Hazel Park), Minority Vice Chair, Main Sponsor, HB 5973
- Julie Brixie (D-Okemos)
- Emily Dievendorf (D-Lansing)
- Kimberly Edwards (D-Eastpointe)
- Rachel Hood (D-Grand Rapids)
- Sharon MacDonnell (D-Troy)
- Jasper Martus (D-Flushing)
- Donavan McKinney (D-Detroit)
- Jason Morgan (D-Ann Arbor)
- Amos O’Neal (D-Saginaw)
- Victoria Paiz (D-Ann Arbor)
- Natalie Price (D-Berkley)
- Carrie Rheingans (D-Ann Arbor)
- Helena Scott (D-Detroit)
- Phil Skaggs (D-East Grand Rapids)
- Samantha Steckloff (D-Farmington Hills)
- Jimmie Wilson (D-Ypsilanti)
- Doug Wozniak (R-Shelby Twp.)
House Bill 5956: Provider Non-Discrimination in Michigan Law
Introduced by state Representative Brenda Carter (D-Pontiac) (pictured), Chair of the House Health Policy and Financial Services Committee, House Bill 5956 (text) is based on Section 2706(a) of the Affordable Care Act. It reads:
An insurer that delivers, issues for delivery, or renews in this state a health insurance policy shall not discriminate with respect to participation under the health insurance policy against a health professional who is acting within the scope of the health professional’s license granted under article 15 of the public health code…
The bill also:
- Does not require insurers to contract with any health professional willing to abide by the terms and conditions for participation established by the insurer.
- Does not prevent an insurer from establishing varying reimbursement rates based on quality or performance measures.
The bill was assigned to the House Insurance and Financial Services Committee. The co-sponsors of HB 5956 (in order of signing on as a co-sponsor) are below. Members of the Insurance and Financial Services Committee are in italics.
- Brenda Carter (D-Pontiac), Chair, Main Sponsor
- Felicia Brabec (D-Pittsfield Township)
- Amos O’Neal (D-Saginaw)
- Mai Xiong (D-Warren)
- Carrie Rheingans (D-Ann Arbor)
- Kimberly Edwards (D-Eastpointe)
- Julie Rogers (D-Kalamazoo)
- Cynthia Neely (D-Flint)
- Stephanie Young (D-Detroit)
- Jason Hoskins (D-Southfield)
- Laurie Pohutsky (D-Livonia)
- John Fitzgerald (D-Wyoming)
- Victoria Paiz (D-Harper Woods)
- Jennifer Conlin (D-Ann Arbor)
- Jim Haadsma (D-Battle Creek)
- Donavan McKinney (D-Detroit)
- Sharon MacDonnell (D-Troy)
- Mike McFall (D-Hazel Park), Majority Vice Chair
- Kristian Grant (D-Grand Rapids)
- Jason Morgan (D-Ann Arbor)
- Kara Hope (D-Holt)
- Doug Wozniak (R-Shelby Township)
- Erin Byrnes (D-Dearborn)
- Jenn Hill (D-Marquette)
- Helena Scott (D-Detroit)
- Abraham Aiyash (D-Hamtramck)
