Regional Solutions to Urban Revitalization

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Insuring Michigans Uninsured Options for
Expanding Access to Affordable Health Care
The Detroit River International Border Crossing
Transportation Infrastructure Options for the
Integrated Policy Exercise Gerald R. Ford
School of Public Policy University of
Michigan Professor Elisabeth R. Gerber
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• Ford School of Public PolicyIntegrated Policy
  Exercise (IPE)
• Multi-day intensive role-playing simulation of
  the public policy process on a current policy
  issue
• Signature annual activity of the Ford School
  Masters of Public Policy program since 1999,
  involving 180 students
• Topic for 2008 was expanding access to health
  care for low and moderate income families in
  Michigan
• Simulated the Michigan Senate decision-making
  process as they evaluate alternative proposals
  for expanding health care access

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• Objectives
• Integrate knowledge and skills acquired during
  the MPP program
• Apply diverse educational experiences to a policy
  debate of immediate importance
• Appreciate complex trade-offs inherent in the
  public policy process
• Experience the demands of public policy
  decision-making under conditions of limited time,
  resources and information
• Build community by involving all Ford School MPP
  students in a single substantive event

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• Scenario
• Assume the Michigan House of Reps has just passed
  a bill (similar to Michigan First) that
  contains
• Medicaid/MIChild expansion
• Private insurance exchange
• Employer mandate with tax incentives
• Technology healthy lifestyle initiatives
• Now its the Senates turn
• Begin with four preliminary proposals
• Single payer system
• Medicaid expansion w/ employer mandate
• Private insurance exchange w/ individual mandate
• Consumer-directed health savings plan w/ tax
  credits

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• Major Activities
• Students engaged in a wide range of activities
  over course of the three-day event
• Student role-playing
• Background research
• Keynote presentations
• Expert panel presentations
• Expert small group meetings
• Strategy development
• Coalition building
• Lobbying
• Legislative sessions
• Legislative hearings
• Press releases
• Referendum/ initiative voting
• Media presentations

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• Role Playing
• Students were assigned to role play a wide
  variety of stakeholders and policy-makers
• Stakeholder organizations
• Business
• Labor
• Patient advocates
• Providers
• Insurers
• State and local government
• Policy-makers
• State Senate
• House members
• Governors office
• Senate Fiscal Agency
• Media

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Role Playing
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Outside Experts
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Outside Experts (cont)
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Outside Experts
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• Process
• Major steps in the simulation included
• Students familiarize themselves with initial
  proposals
• Stakeholders identify their initial positions
• Senators write bills
• Stakeholders build coalitions, lobby Senators
• Senators vote on a bill
• Stakeholders lobby conferees
• Conferees pass conference report
• Stakeholders lobby Governor
• Governor signs/vetoes
• Stakeholders propose/qualify initiatives
• All vote on referendum and initiatives

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• Voting

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• Final Outcomes
• Final law contained provisions for
• Medicaid/MIChild expansion to cover kids up to
  300 FPL, working parents up to 150, nonworking
  parents and childless adults up to 100 and
  pregnant women up to 250
• Established an insurance exchange to provide new
  private insurance instruments, plus a state
  subsidy tied to family income
• 8 of 15 amendments passed
• Referendum failed (i.e., law was not repealed)
• One initiative passed, required state to serve
  healthy foods at state-sponsored meals
• One initiative failed, would have replaced
  current law with a single payer system