State Exchange is about Monopoly Control

Monopoly DefinitionMonopoly Control

It’s been a busy week for Michigan insurance regulators. It’s all good if you like monopoly control.

I don’t.

Monopoly decreases choice where we live and work. It concentrates power at the top. It creates complacency and saps incentive to serve.

Last week, I noted that Blue Cross Blue Shield of Michigan promotes ESG. Today, it provides an example of near-monopoly, as it holds health insurance plans for 68% of Michigan. The next-largest, Spectrum Health, has only 12%.

Thanks to BCBS, Michigan remains the second-most consolidated health insurance market in the US, according the the 2022 AMA Competitiveness Study and Map.

But there’s more. See if you can figure out the villain in the story. (All of the above is a perfectly acceptable answer.)

Playlist of institutions and acronyms:

DIFS = (Michigan) Department of Insurance and Financial Services
MDHHS = Michigan Department of Health and Human Services
BCBS-MI = Blue Cross Blue Shield of Michigan
NAIC = National Association of Insurance Commissioners
DTMB – (Michigan) Department of Technology, Management, and Budget

On Tuesday

DIFS Director Anita Fox was appointed to Chair the NAIC Health Insurance and Managed Care Committee. Among other things, the committee is tasked with “emphasizing equity considerations” and lobbying the US Congress. (For example, passing the ACA/Obamacare.)

On Wednesday

A DIFS liaison was sole presenter at the first Senate Health Policy Committee hearing. His plan came off more like expectations than suggestions: the Legislature is to produce a State Exchange bill – pronto. As in, this month.
Here’s the timeline he provided.

State Exchange MI timeline Like me, you may be old enough to remember when Governor Snyder tried to do the same thing.  In fact, ten years ago he created DIFS specifically to implement the ACA/Obamacare state exchange.

With Governor Snyder, the saying in Lansing was, “What the governor wants, the governor gets.” He wasn’t above arm-twisting “his” legislative caucus, and Governor Whitmer may do the same.

The parallels are remarkable: both chambers of the legislature controlled by the same party as the governor, taking up the same question, with the same flawed arguments. The only difference is that now it’s the opposite party.

To give the Senate Health Policy Committee its due credit, two senators (one from each party) asked questions that showed weaknesses in the DIFS argument. You can watch the 19-minute hearing here.

Optional Quiz:

  1. List the benefits DIFS claims for a state-based exchange.
  2. What flaws can you see in these claims?
  3. Here’s a freebie: Who really benefits??
    Many departments in Michigan’s government would benefit from a state exchange. However, the greatest initial profit would go to Michigan’s least-known and most frequently over-budget department: DTMB.

Obviously, this is not about party differences, though many will expect Democratic legislators to march in lockstep. (Just as Republicans called for party unity a decade ago.)

Take Control Today

Many institutions want elite, top-down control of healthcare, and health insurance holds the money. Michigan’s chief executive is counting on the people’s elected lawmakers to deliver money and control to the state with the exchange.


The reality is, your healthcare freedoms and constitutional separation of powers are both at stake.

Michigan lawmakers need to know the people want an independent legislature that works for them.

Not for the governor. Not for special interests. And not for any (or all) of the departments in state government.

Eventually, there will be a bill number – probably more than one. I suggest you not wait until then to contact your state senator with your objections to the state exchange.

Find your Michigan Senator, Health Policy Committee hearings, and legislative schedule here.

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