If nothing else, the debate over Proposal 4 generated a great deal of awareness about problems facing health care providers in Michigan.
Now, with voters overwhelmingly turning down the constitutional amendment to redirect the millions the state receives annually in the national tobacco settlement, Spectrum Health President and CEO Rick Breon is hopeful that awareness can translate into action to address what ails health care, most notably the underfunding of Medicaid.
“It certainly put health care right at the top of people’s minds in the election,” Breon said last week following Proposal 4’s crushing defeat. “People are now talking about health care as a real issue in the state.”
Spectrum Health was among a handful of hospitals that opposed Proposal 4 — also known as the Healthy Michigan Amendment — even though they would have benefited from it financially. The Grand Rapids-based health system even contributed $260,000 last month to a group consisting largely of education and business interests that fought the proposal.
Even the leader of the group that opposed Proposal 4 agrees that health care and how to pay for it needs to rise to the top of the agenda in Lansing for legislators and governor-elect Jennifer Granholm.
“We have a health care crisis in Michigan,” said David Waymire, a Lansing lobbyist who helped to run the anti-Proposal 4 campaign for People Protecting Kids and the Constitution. “Everybody has to come to the table. Everyone has to sacrifice.”
Proposal 4 would have constitutionally mandated that 90 percent of the $300 million to $364 million that Michigan receives annually as part of the 25-year tobacco settlement go toward health care, medical research and anti-smoking programs. The state’s general fund would then receive the remaining 10 percent.
The Citizens for a Healthy Michigan coalition claimed the money from the settlement was supposed to go for those purposes. But opponents of the measure contended that the aggrieved parties in the litigation were the taxpayers, and that the settlement was to reimburse states for what they already had spent to care for people with tobacco-related illnesses.
Gov. John Engler, who vehemently opposed Proposal 4, and the Legislature earmarked the bulk of the money in 1999 to fund college scholarships of up to $2,500 for high school students who score at a certain level on the state’s MEAP tests. More than $129 million in MEAP Merit Scholarships were awarded to 51,733 students this year.
The rest of the money goes into a trust fund to help low-income senior citizens pay for prescription medications and to provide up to $50 million annually to fund development of the state’s Life Sciences Corridor initiative.
Opponents of Proposal 4 contended it lacked public oversight or accountability in how health care interests spend the money and would have broken the state’s promise to high school students who were counting on a MEAP scholarship. They also said that tinkering with the state Constitution was an improper way to address financial problems for health care.
“We just didn’t think that was the right process and the right format,” said Breon, who may have a role in shaping future health care policy.
He is among a group of health care executives Engler recently appointed to a new advisory commission that will examine a myriad of issues, including disbursement of Medicaid money for hospitals with a disproportionate share of indigent patients. The question now is whether the Hospital Advisory Commission will go forward under the new administration in Lansing that takes power in January.
“The whole issue of health care in general needs more attention and discussion. We look forward to having that dialog,” Breon said.
As does the Michigan Health and Hospital Association, the primary proponent of the Proposal 4.
In a statement issued the day after last week’s election, association President Spencer Johnson vowed to continue pushing for using more of the tobacco settlement for health care. Health care, he said, has become a top priority in Michigan.
“The volunteers of Michigan’s hospitals and other health care organizations … will continue to impress upon the new Legislature that the core issues of the proposal are crucial for Michigan communities. Today is just the beginning of our new Healthy Michigan Initiative.”
The $260,000 from Spectrum and other contributions by hospitals and health systems that totaled nearly $2 million enabled the anti-Proposal 4 group to get on the air in the final 10 days before the election with television ads featuring former Attorney General Frank Kelley.
The ads, combined with an outreach to news media to urge newspaper editorials against the measure, led to Proposal 4 losing statewide by a 66 percent to 34 percent margin. The margin was even larger in Kent County — 75 percent to 25 percent.
“We controlled the message in the last month of the campaign,” Waymire said.
The organization’s polling data showed Proposal 4 supported by about 55 percent of voters in the weeks leading up to the Nov. 5 election, a level that indicated weakness because the countermeasure had yet to mount much of an effort, Waymire said.
“The support for this was a half an inch thick. That told us if we could get a little bit of information out, it would do a lot of good,” he said. “It just toppled on its own weight.”