New bill seeks to establish state-based health care system

LANSING/METRO DETROIT — A proposal for a new state-based, single-payer health care system is now in committee in the Michigan House of Representatives, while its sponsor seeks feedback from the public.

State Rep. Carrie Rheingans, D-Ann Arbor, is behind the proposal, House Bill 4407, known as MiCare. She was joined by fellow state representatives Mike McFall, D-Hazel Park, and Stephanie Chang, D-Detroit, at a town hall on the topic Jan. 23 at Plumbers Local Union 98 in Madison Heights. Despite the windchill approaching 20 below that night, there were still around 30 people in attendance.

“We are still in the early stages of it. It’s one of the reasons Rep. Rheingans has been hosting these town halls,” McFall said. “We have been trying to get input from people across the state, listening to their stories. We’ve heard from people who either don’t have insurance and can’t pay out of pocket for it, or their insurance barely covers their treatments or whatever else they need. Our current system is a dying system. We need to come up with something for everyone.”

The trio said the program aims to provide universal coverage to all Michiganders — regardless of income, assets or health status — without deductibles, co-insurance, co-pays, or caps on coverage amounts.

This includes access to primary care, preventative care, chronic care, hospital services, mental health services, prescription drugs, medical devices, dental care, vision care, hearing care, substance use disorder treatment, reproductive health care, long-term care and in-home care, laboratory services, gender-affirming care, organ donation and transplantation, autism treatment, ambulance services, hospice care and more.

“Health care is a fundamental human right. All 10 million Michiganders, regardless of where in the state they live, deserve to have high-quality, affordable health care and the freedom that comes with that,” Rheingans said in a statement. “No Michigan resident should have to live in fear of becoming bankrupt if they or their loved one gets sick — something many people with health insurance still have to worry about.”

If the program moves out of committee and is approved by the state Legislature, a fund would be created in the state treasury to finance the program. The state would also seek to include federal health care dollars from Medicaid and the ACA marketplace.

To do this, the Michigan Department of Health and Human Services would request waivers from the Centers for Medicare & Medicaid Services to transfer the state’s funding allocation for Medicare, Medicaid, MIChild and the exchange. There would also be an amendment to the Employee Retirement Income Security Act of 1974, or alternatively, an exception would be made so that plan holders’ funding can be added to the MiCare fund.

The program would also require a change to the state’s taxation structure to be progressive, asking the highest earners to shoulder more of the cost. Officials say this would likely require a constitutional amendment to overturn the Headlee amendment passed in 1978.

Additional funding would come from a graduated health care assessment on payroll and other income types, including capital gains. Employers would cover 80% of payroll assessment, while individual income up to $25,000 would be exempt.

Even with this new state revenue, the bills’ sponsors expect direct savings for most Michiganders and employers since the program would likely displace private health care spending.

MiCare would be overseen by an independent board that would be tasked with controlling costs and the expansion of services. The board would be bipartisan, with 13 members nominated by the speaker and minority leader of the House and selected by the governor. No more than seven members would be chosen by the same political party.

According to the U.S. Census Bureau, as of 2023, roughly 433,000 Michiganders did not have health insurance coverage. Between 2023 and 2024, about 1.1 million Michiganders lost Medicaid coverage through the redetermination process, so the current uninsured population is likely higher.

According to the Kaiser Family Foundation, 47% of American adults last year said it was “very” or “somewhat” difficult to afford their health care costs, while 21% said they or a family member in their home did not fill a prescription last year due to cost.

The foundation also found that as of 2020, health care costs for the average Michigander had risen nearly $10,000 annually, and in 2024, the employer contributions for health insurance averaged nearly $9,000 per single employee and more than $25,000 for family coverage nationally.

McFall encouraged people to write to Rheingan’s office with their own stories or concerns.

“The current health care system is not sustainable,” McFall said. “It’s not working for many people or even small businesses — their costs are also getting higher, and much of that gets shifted over to the employees. We’re all paying a lot out of pocket, be it high deductibles or premiums. We can’t keep putting Band-Aids on the problem. Something needs to change.”

A request for comment from the Michigan House Republicans went unanswered by press time.