Because this package seems certain to come up for House Insurance Committee vote this term, I wanted to post a good summary of the issues.

The Daily Telegram fits that description.

However, one aspect is left unexplored. More below.

Michigan Senate passes bills modifying no-fault auto insurance overhaul

Clara Hendrickson  |   October 21, 2023

The Michigan Legislature held its first vote Thursday on legislation to modify the state's 2019 no-fault auto insurance overhaul that aimed to lower costs for drivers but led some medical providers to close their doors to car crash victims.

Lawmakers in the state Senate passed legislation to increase reimbursement rates for medical providers treating car crash victims in Michigan.

It takes courage for lawmakers to revisit laws that need improving, said Senate Majority Leader Winnie Brinks, D-Grand Rapids. State Sen. Mary Cavanagh, D-Redford Township, who sponsored the primary bill in the package has characterized her effort as a way to fix what she calls the unintended consequences of Michigan's 2019 no-fault auto insurance changes. That overhaul imposed a 45% payment cut to providers of services frequently used by catastrophic accident survivors. Providers have characterized the change as devastating for their businesses and the patients they serve. However, earlier this summer, the Michigan Supreme Court ruled that the cuts don't apply to those injured in car crashes before June 2019, when the no-fault overhaul was signed into law.

The legislation passed 23-14 Thursday. Four GOP lawmakers joined most Democrats to support the bills: state Sens. Jon Bumstead, of North Muskegon, John Damoose, of Harbor Springs, Ruth Johnson, of Holly, and Rick Outman, of Six Lakes. State Sen. Sylvia Santana, D-Detroit, was the lone Democrat to vote against the package. State Sen. Jim Runestad, R-White Lake, abstained from voting.

Sen. Joe Bellino, R-Monroe, who represents most of Monroe, Lenawee and Hillsdale counties, voted against the legislation, as did Sen. Jonathan Lindsey, R-Allen, who represents the western-most townships in Hillsdale County. Sen. Jeff Irwin, D-Ann Arbor, voted for the bills. He represents northeastern Lenawee County and the city of Milan as well as a large part of Washtenaw County.

One lawmaker described changes as overdue and conceded that they might arrive too late for some. "Even if we fix this today, some of the damage is permanent and cannot be undone," said state Sen. John Damoose, R-Harbor Springs, in a speech in which he recounted the providers shuttered in the wake of the 2019 auto insurance overhaul.

Cavanagh said Michigan lawmakers can address the state's "crisis of care" without impacting the cost-saving features of the current law. But other Republican lawmakers worried about the bills' impact on insurance costs for drivers. State Sen. Ed McBroom, R-Waucedah Township, blasted the bill package, calling it a "pile of junk." In heated remarks, he said his constituents sent him to Lansing with one demand on car insurance: lower costs. "It's ridiculously expensive in this state. Insanely expensive in this state," he yelled.

Together, Senate Bills 530, 531 and 575 would raise the reimbursement rates for providers who treat those in more recent auto accidents. Lawmakers amended the legislation, which originally proposed a 250% reimbursement rate of whatever Medicare pays to medical providers. It now no longer includes an across-the-board rate increase for providers. Instead, it preserves a tiered system with smaller rate reimbursement increases for different types of providers.

The head of the Department of Insurance and Financial Services (DIFS) came out against the bill package, predicting it would raise insurance costs.

"Simply put, the broad-brush reimbursement rate increases proposed in these bills would substantially impact auto insurance affordability across the state," department director Anita Fox wrote in a letter to lawmakers Wednesday. While Fox submitted that written testimony before lawmakers made changes to the legislation, the revisions did not sway the department to support the bills, according to a spokesperson.

"Now I don't say this often but I agree with the Whitmer administration," said Minority Senate Leader Aric Nesbitt, R-Porter Township.

State Sen. Lana Theis, R-Brighton, pointed to DIFS's concerns in a floor speech ahead of the vote Thursday and expressed concerns that the legislation would increase the share of Michigan drivers without insurance traveling on the state's roads. Lawmakers rejected an amendment from Theis that would have ensured that none of the changes in the legislation would take effect if DIFS found that insurance costs would go up.

State Sen. Jeremy Moss, D-Southfield, said that the 2019 auto insurance overhaul did not deliver the promised rate relief for drivers and countered that Theis' amendment wouldn't either. "The heart of the bill is to restore access to health care," he said.

Groups advocating for catastrophic crash survivors who heralded the summer state Supreme Court decision now want lawmakers to send the legislation changing reimbursement rates to Whitmer's desk.

State Sen. Sarah Anthony, D-Lansing, said she does not want lawmakers to go another year hearing the same demands from families of survivors of catastrophic car crashes who have lined the halls of Lansing demanding changes.

The legislation passed by the state Senate on Thursday will next head to the state House for consideration.

https://www.lenconnect.com/story/news/politics/state/2023/10/21/michigan-lawmakers-vote-on-auto-insurance-bills/71252435007/

As the article notes, longterm care crash victims, families, and homecare agencies unite in saying that reduced pay is unacceptable. Caregiver supply is drying up. Agencies are going out of business.  

Why? 

Certainly, auto insurance created a two-tier reimbursement system. I remember being on call for OR and hearing other services being called in as "car crash" specifically. We were all about saving lives, but double reimbursement gets a special response.

Still, auto insurance reimburses homecare no lower than Medicaid does. Disabled Medicaid patients are going on the same as ever, short staffing, low pay, and all. 

Did certain homecare agencies (and caregivers) become dependent on elevated rates for a share of their clientele? So dependent, that without these rates, they can't survive? 

If so, what does that say about state Medicaid reimbursement rates?

This side of auto no-fault reform demands answers in the era of fat Michigan budgets.