039. Michigan

A discussion on our state.


Questions to ponder

  1. Who are you and where are you from? (And how far is it from here?)
  2. In her 2019 State of the State, Governor Whitmer stated that, “the vehicle damage from our roads costs the average motorist $562 a year in repairs. We’re paying a road tax that doesn’t even fix the damn roads. That’s money that could go toward childcare, rent, college tuition, or retirement savings.” If each resident of Michigan had an extra $562, where should those funds go to optimize the overall well-being of said residents.
  3. What are the (health) consequences of poor infrastructure?
  4. Are the residents of Michigan generally healthy? Do they suffer from any chronic diseases with greater regularity than other states’ residents? If so, which and where does they stem? If not, why is Michigan such a representative state?
  5. What could be done to make the residents of Michigan generally healthier?
  6. Should there be more Michiganders or fewer? Should there be more Detroiters or fewer? Should there be more Ann Arborites or fewer?
  7. Why doesn’t Flint have clean drinking water?
  8. In recently denying a petition for a writ of certiorari in the case City of Flint et al. v. Shari Guertin, the Supreme Court of the United States has signaled that state and local government officials can be sued for their involvement in the Flint water crisis. How ought the people responsible be held to account?
  9. Foster Friedman and Udow-Phillips (2018) identify four current issues with health/care spending and outcomes in Michigan: (1) Medicaid and the Healthy Michigan Plan; (2) individual market coverage and the health insurance marketplace; (3) opioids; and (4) integration of services. Given the state of our state, how should these issues be prioritized/worked through?
  10. “In June 2018, Governor Snyder signed PA 208 into law, the first step in preparing a work requirement proposal for Michigan. Beginning in 2020, the law would require non-elderly, non-disabled HMP enrollees aged 19-62 to document an average of 80 hours of work per month to maintain eligibility for Medicaid benefits.” Should health/care as such be bound to work? Should there be any consideration for the populations covered by such insurance?
  11. Is Michigan a bubble? As an early adopter of Medicaid managed care and statewide managed care program as early as 1997, Michigan has historically had an uninsured rate less than the national average. “In 2009, 12.2 percent of Michigan residents were uninsured compared with a national average of 15.1 percent. In 2015, 6.1 percent of Michigan residents were uninsured, compared with a national average of 9.4 percent.” The University Hospital generates revenues totaling between 0.1 and 0.2% of America’s overall healthcare spending. What is the Michigan difference?
  12. Will Michigan be red or blue in 2020? (Or will it be some other color entirely?)

Essays to consider

  1. 2019 State of the State
  2. Michigan Health Policy for the Incoming 2019 Gubernatorial Administration
  3. ACA Exchange Competitiveness in Michigan
  4. Flint Water Crisis: What Happened and Why?

A few facts

  • ~10 million people live in Michigan, making it the 10th most populous state;
  • 5.8% of the population is under 5 years old;
  • 22.1% of the population is under 18 years old;
  • 16.2% of the population is over 65 years old;
  • 50.8% identifies as female;
  • 79.6% self-identify as white alone (decrease from 88.3% in 1970);
  • 14.2% self-identify as black alone (increase from 11.2% in 1970);
  • In 2016, Michigan’s estimated gross state product was ~$490 billion (13th in the nation);
  • Michigan became the 24th Right to Work state in the U.S. in 2012;
  • In 2009, emerging from Chapter 11 bankruptcy, General Motors, Ford, and Chrysler reached an agreement with the United Auto Workers Union to transfer the liabilities for their respective health care and benefit funds to a 501(c)(9) Voluntary Employee Beneficiary Association, which has at least in GM’s case been likened to a “Canadian-style” health care payment system;
  • Flint still doesn’t have clean drinking water.