The Michigan Chamber of Commerce opposes any initiative to legalize marijuana in the state.

Background

Since 1995, the Michigan Chamber Foundation's DRUGS DON'T WORK program has assisted local chambers and employers in implementing drug-free workplace programs. A model progra consists of a policy, n Employee Assistance Program, supervisory training, employee education, and at least pre-employment drug testing.

This past year, a petition was undertaken in Michigan to qualify a constitutional amendment for the November 2000 ballot to legalize marijuana. Petitions circulated by a Saginaw attorney and a reported 3,000 volunteers gathered only half of the 300,000+ valid signatures required for a constitutional amendment to be placed on the statewide ballot. The initiative, called the "Personal Responsibility Amendment," would have allowed the possession of three marijuana plants and three ounces of marijuana. It also would have striped law enforcement of using forfeiture funds. (Forfeiture funds are assets such as cash and vehicls seized from drug dealers. These monies are then used for future law enforcement or prevention activities.)

This Libertarian approach has varied from other state initiaives that focus mainly on "medical marijuana." In 1996, both California and Arizona passed legalization propositions. California's Prop 215 allows individuals to use marijuana for any "medical condition" with just a doctor's verbal recommendation. There is no age limit or limit on the amount of marijuana. In Arizona, all Schedule I drugs were legalized for everyone. (Schedule I drugs are drugs for which there is a high potential for abuse, no currently acceptable medical use in treatment and a lack of accepted safety for use under medical supervision. Heroin, LSD, and marijuana are Schedule I drugs.)

In both states, more than 70 percent of the funding for the pro-legalization campaign was from out-of-state sources. New Yorker George Soros gave $550,000 to the California effort and $430,000 to the Arizona initiative. Two other large contributors ($500,000 & $200,000) indluded Peter Lewis of Ohio and John Sperling of Arizona. Other states which have passed similar "medical-excuse marijuana" initiatives include Oregon, Washington, Alaska, and Maine. Other pro-legalization organizations include the Drug Policy Foundation, NORML (National Organization for the Reform of Marijuana Laws), and Americans for Medical Rights.

The Drug Free America Foundation, based in Florida, is working to educate Americans about ballot initiatives and other attempts to legalize as "medicine" unsafe, ineffective and unapproved drugs such as marijuana and heroin. In May, the Drug Free America Foundation came to Michigan for a two-day conference on potential consequences of the legalization movement. Participants in the conference included representatives from the Michigan Chamber Foundation's DRUGS DON'T WORK program community coalitions, the Prosecuting Attorneys Association of Michigan, and the Drug Enforcement Administration.

Although the "Personal Responsibility Amendment" is not on the November ballot, any future attempt to legalize marijuana would be harmful for the following reasons:

1. Creates conflict with federal law. Marijuana is a controlled substance under federal law, listed on Schedule I. In addition, marijuana is one of five prohibited drugs tested for in the Omnibus Transportation Employee Testing Act of 1991 which covers safety-sensitive positions (Department of Transportation, Federal Aviation, etc.) Under the Federal Drug Free Workplace Act, the recipients of certain federal grants or contracts must have policies that prohibit the use of illegal drugs.
2. Removes marijuana from the drug approval process. Testing by FDA and other government agencies is designed to protect public health. Legalizing marijuana through a ballot initiative would circumvent this process. Smoking crude marijuana is an impractical delivery system. The dosage cannot be controlled and the chemical make-up of any two plants can differ significantly. Smoking is clearly a health risk and marijuana smoke contains even more carcinogens and tar than cigarettes (Jonsson Cancer Center @UCLA). Other approved drugs are generally more effective. THC, the active ingredient in marijuana, is available by prescription as Marinol (a Schedule II drug) to treat nausea associated with some cancer treatments.
3. Raises concerns about the safety and health of employees. In a study by Workplace Consultants, results showed that drug-using employees are three times more likely than non-using employees to be involved in a workplace accident and are fivetimes more likely to file a workers compensation claim. Impaired employees hurt themselves, their co-workers and overall business productivity. Legalization would invalidate a drug-free workplace program, thereby losing a chance for early intervention and a resource for help. Legalization would also create a new group of people unfit to hire because of their drug dependence.
4. Sends dangerous message to the future workforce. There is a direct correlation between perceived harm of a drug and its use. At the peak of drug use in the late 70s, results of the Monitoring the Future Study (U of M) 37 percent of high school seniors had used marijuana in the prior 30 days and 10.7 percent used marijuana daily. Following a solid national anti-drug message, the results were dramatically different in 1992. Marijuana use in the prior 30 days by high school students dropped to 11.9 percent and daily use dropped to 1.9 percent. Legalizing marijuana would certainly erode the perceived risk of drug use.

The Michigan Chamber of Commerce opposes the proposed amendment to the state constitution entitled Dedication of Tobacco Tax and Settlement Revenue to Improvement of Health Care because additional earmarking of funds in the state constitution restricts the ability of the legislature to make necessary decisions about the proper allocation of the state's financial resources in response to changes in the economy and the various needs of Michigan's citizens.

Background

Over a period of months during late 2001 and early 2002, members of the Chamber's legislative staff met with members of the legislative staff of the Michigan Health & Hospital Association (MHHA), which is spearheading the effort to pass this constitutional amendment. During those meetings, we made clear the Chamber=s longstanding belief that the settlement revenues should originally have been used for health care purposes and that the provider community had failed to advocate for that allocation when the legislature created the merit scholarship program.

Further, we advised the MHHA to lobby for a legislative solution, and against seeking a constitutional amendment. We also encouraged them to refrain from attempting to secure such a large percentage of the settlement monies, instead leaving at least enough budget flexibility for a means tested merit scholarship program.  We also made it clear that the Michigan Chamber has Board policy, and support from the Michigan Business Leaders for Education Excellence (MBLEE), for the merit scholarship program. Unfortunately, the MHHA and its allies proceeded in a different direction.

It should be noted that the MHHA was the only health care advocacy group that did not advocate for a "pause" in the rollback of the Single Business Tax in order to direct additional funds to health care. They, and other health care advocacy groups, did support the excise tax increase on tobacco products, which the Chamber opposed. 

While the Chamber agrees that the state has continued to under fund Medicaid, and acknowledges that state under-funding leads to cost-shifting adversely affecting employers who pay for employer health benefits, we believe a more equitable allocation of state funds from all sources can, and should, be made through the appropriations process.

The Michigan Chamber's Health and Human Resources Committee recommends adoption of this Policy Proposal.

The Michigan Chamber recognizes the significant challenges facing the health care profession, including shortages of trained personnel in nursing and other specialties due to increased utilization and an aging population. The Chamber believes issues such as mandatory overtime and nurse-to-patient staffing ratios should be addressed in the workplace by hospital employers and employees, not by state or federal legislation that ignores the needs of patients and the communities in which they live. Further, we believe all interested parties should work collaboratively to expand enrollment in nursing programs, break the barriers to entry into the nursing profession, ensure the retention of existing nurses, and improve quality and safe care in hospitals through sound management and marketplace solutions.

Background

The Michigan health care community is faced with the challenge of providing quality and access to care at a time when there is an acute shortage of caregivers. At the same time, the health care community is confronted with various legislative proposals to mandate nurse-to-patient ratios and eliminate mandatory overtime for registered nurses.

Senate Bill 1190 is the Michigan Nurses Association’s most concerted effort to push through legislation that would mandate nurse-to-patient staffing ratios in Michigan hospitals and prohibit mandatory overtime. House Bill 5049 and Senate Bill 669 are similar bills being pursued by others in the nursing community.

Proponents of these bills argue that legislation is necessary to reduce some of the most serious threats to patient safety and quality of care. They argue that lower nurse-to-patient staffing ratios would result in higher job satisfaction, lower burnout, higher rates of retention, and lower rates of turnover among nurses. Further, they argue that the legislation should prohibit mandatory overtime because it forces exhausted nurses in short-staffed facilities to work long consecutive hours--thereby compromising patient safety.

Opponents of these bills argue that the legislation is capable of having the exact opposite effect of its stated purpose. They argue that the critical shortage of nurses in Michigan and nationwide would cause hospitals to have to curtail services and close beds if they are faced with having to fill a one-size-fits-all ratio. Further, they argue that a one-size-fits-all approach to the state’s hospital system is risky, inefficient and wasteful because ratios do not take into consideration the ongoing assessment of patients’ needs, the differences in the skill levels of nurses, the availability of other ancillary workers and support services, or the types of equipment and technology available in a particular hospital.

The Chamber’s Health and Human Resources Committee heard presentations from the Michigan Nurses Association and the Michigan Health and Hospital Association regarding this issue at its September 15, 2004, Committee Meeting. After listening to both sides of the debate, the Committee unanimously agreed to recommend to the Board of Directors that the Michigan Chamber oppose legislative efforts to mandate nurse staffing ratios and prohibit mandatory overtime. Although the Committee agrees that these issues are valid employee concerns, they believe it is imperative for hospitals to have the flexibility to manage staffing based on patient needs and the skills and competencies of their staff—without governmental interference. The Committee believes nurses, hospitals and other interested parties should work collaboratively to encourage individuals to enter the field of nursing, work with colleges and universities to support and expand nursing programs and scholarship opportunities, and explore opportunities for tax credits and other marketplace solutions.

The Michigan Chamber supports Medicaid reform based on the following principles: 

• Reforms to the Medicaid system must provide suitable coverage to eligible recipients;
• Restructuring the state’s Medicaid payment methodology in a manner that rewards high-quality, low-cost health care providers;
• Reducing the cost-shift of Medicaid to the private sector by addressing the state’s chronic underpayment to providers and highlighting the exceedingly low Medicaid reimbursement rates, especially compared to Medicare;
• Incorporating individual responsibility, consumerism, cost transparency and incentives for health behavior in Michigan’s Medicaid program;
• Physicians are currently under compensated for the care they provide Medicaid recipients. The state must pay providers at least the cost of services.

Background

The Medicaid program was established in 1965 under Title XIX of the Social Security Act. Medicaid is a federal-state partnership and was designed to finance health care services for the nation’s poor. Medicaid’s original focus was on recipients of cash assistance through welfare programs, but the program was expanded in 2003 to fund health services for approximately 52 million low income Americans, including single parents with children, and the elderly, blind and disabled. With Medicaid expenditures soaring and state revenues dropping, the Medicaid system is in dire need of reform. In Fiscal Year 2006-07, the State of Michigan will spend over $7 billion on the Medicaid program to cover approximately 1.4 million – or one in seven – Michigan citizens who are eligible under state and federal guidelines. Today, Medicaid is the largest payer of health insurance benefits for America’s – and Michigan’s – poor. 

In May and September of 2006, the Chamber’s Health and Human Resources Committee heard presentations from the Grand Rapids Chamber of Commerce regarding it’s business case for Medicaid reform, set forth in a position paper titled “A Business Case for Medicaid Reform.” The Committee unanimously voted to support the proposal, recognizing that sensible reforms to Medicaid are necessary to stem the burgeoning cost of health care not only for the State of Michigan but also for Michigan job providers who are currently subsidizing uncompensated and under-compensated health care costs – in the amount of over $1.3 billion – for Michigan’s uninsured, Medicaid and Medicare populations when they purchase health insurance for their employees in the private marketplace.

The Michigan Chamber is neutral on a proposed ballot initiative to legalize marijuana for medical proposes. 

Background

In September of 2000, the Michigan Chamber’s Board of Directors adopted Board policy to “oppose any initiative to legalize marijuana in the state.”  This Board policy was developed and adopted in response to a petition drive undertaken in Michigan to qualify a constitutional amendment for the November 2000 ballot to broadly legalize marijuana. The initiative, called the “Personal Responsibility Amendment,” would have allowed the possession of three marijuana plants and three ounces of marijuana for any purpose.  It also would have stripped law enforcement of using forfeiture funds (i.e., assets, such as cash and vehicles, seized by drug dealers then used for future law enforcement or prevention activities).  Ultimately, the petition drive failed when petitioners failed to gather more than half of the 300,000+ valid signatures required for a constitutional amendment to be placed on the statewide ballot. 

Although in 2000 the so-called “Personal Responsibility Amendment” failed to qualify for the ballot, the Michigan Chamber’s Board of Directors reviewed the issue and voted to oppose any similar initiative for the following reasons:  it creates a conflict with federal law; removes marijuana from the drug approval process within the federal Food and Drug Administration (FDA); raises concerns about the safety and health of employees; and sends a dangerous message to the future of the workplace.

In November of 2007, the Michigan Coalition for Compassionate Care submitted just under 500,000 signatures to qualify a carefully drafted and more narrowly focused initiative for the ballot to allow seriously ill patients to use, possess and grow their own marijuana for medical purposes with their doctors’ approval. Under this initiative, if certified by the Michigan Board of Canvassers and passed by the voters in November 2008, Michigan would become the twelfth state – and the first in the Midwest -- to have a law on its books to allow patients to use medical marijuana despite federal law. 

The ballot initiative being proposed in Michigan would do the following: allow terminally and seriously ill patients to use medical marijuana with a doctors’ approval; protect these patients from arrest and prosecution for the use of medical marijuana; permit patients and caregivers to cultivate their own medical marijuana for medical use, with limits on the amount they could possess and where it may be grown; create registry identification cards for law enforcement purposes and establish penalties for false and fraudulent ID cards; allow patients and caregivers who are arrested to discuss their medical use in court; and prohibit the use of medical marijuana in public places. It is important to note that the language expressly states that the proposal would not require “[a]ny employer to accommodate the ingestion of marijuana in any workplace or any employee working while under the influence of marijuana.”

Although the proposed ballot initiative seems to legalize medical marijuana under state law, its use would remain a criminal offense under federal law. However, proponents are not deterred by this fact, arguing that the federal government cannot force states to have laws that are identical to federal law, nor can the federal government force state and local police to enforce federal law. In addition, proponents’ claims 99 percent of all marijuana arrests in the nation are made by state and local (not federal) officials, thereby protecting 99 out of every 100 medical marijuana users who otherwise would have been prosecuted. 

In December of 2007, the Chamber’s Health and Human Resources (HHR) Committee heard a presentation from a spokesperson for the Michigan Coalition for Compassionate Care regarding their proposed ballot initiative to legalize medical marijuana. Following this presentation, the HHR Committee overwhelmingly voted to recommend to the Board of Directors of the Michigan Chamber of Commerce that the Chamber remain neutral on this latest ballot proposal. The Committee’s recommendation was largely based on the language in the most recent ballot proposal, which minimizes the impact on the workplace, agreeing that employers could work with the language as they do with other “no tolerance” policies for alcohol and other drugs. The Committee acknowledged the concerns raised by the Chamber Board in 2000 (i.e., that the widespread legalization of marijuana would be harmful because it removes it from the FDA approval process and creates conflicts with federal law), but felt the priority of the Chamber in reviewing this legislation should be to look at it from a workplace/employer’s perspective. In addition, the Committee felt the benefits this legislation could potentially offer the seriously ill, in the form of pain management, outweighed these concerns. 

The Michigan Chamber of Commerce is opposed to a proposed ballot initiative to insert “Health Care Security” language into the State Constitution that would require the Legislature to “pass laws to make sure that every Michigan resident has affordable and comprehensive health care coverage through a fair and cost effective financing system.”

Background

In January of 2008, the Michigan Health Care Security Campaign (“Campaign”) began gathering the required 380,012 signatures to qualify a constitutional amendment for the November 2008 ballot. The ballot question is worded as follows: “The State Legislature shall pass laws to make sure that every Michigan resident has affordable and comprehensive health care coverage through a fair and cost effective financing system. The Legislature is required to pass a plan that, through public or private measures, controls health care costs and provides for medically necessary preventative, primary, acute and chronic health care needs.”

In February of 2007, the Chamber’s Health and Human Resources (HHR) Committee heard a presentation from a spokesperson for the Campaign regarding their proposed ballot initiative. The proponents explained that their strategy was not to put forward a specific set of reforms, but rather to bring about a strategy for reform and to deepen the Legislature’s commitment to tackling health care reform. Groups supporting the Campaign include the SEIU Healthcare Michigan, MichUHCAN, Michigan Legal Services, Gamaliel Michigan, MOSES, Cabrini Clinic, Michigan Medical Students’ Association, ACORN, Detroit Wayne County Health Authority, UNITE/HERE, Area Agency on Aging Association, Michigan Osteopathic Association, AFSCME Counsel 25 and others.

Following the Campaign’s presentation, the HHR Committee unanimously voted (with two members abstaining) to recommend to the Board of Directors that the Michigan Chamber of Commerce oppose this ballot proposal, citing several primary concerns with the ballot initiative as written:

1. Constitutional Amendment: This language doesn’t need to be – nor should it be – in the Michigan Constitution. There is nothing stopping the Legislature from amending state law to put such a program in place today. 
2. Definitions: Because the language contained in the Constitutional Amendment is broad and undefined, it could be interpreted differently by different people. Every key word found in this Constitutional Amendment (e.g., “affordable,” “comprehensive,” “fair,” “cost effective,” etc.) could be subject to years of litigation. As a result, court opinions – not legislators – would ultimately be writing these laws and, even then, the meaning of these laws would be subject to change over time as different courts change the meaning of the various definitions. 
3. Cost: Although proponents of this Constitutional Amendment argue that their goals can be achieved without adding to the overall cost of health care in Michigan, this proposal is drafted to “make sure that every Michigan resident has affordable and comprehensive health care coverage through a fair and cost-effective financing system” through public or private measures. Unless achieved through private measures, it is difficult to imagine how this could be achieved under the State’s current health care financing system without a significant tax increase – or without moving Michigan in the direction of a single-payer state.
4. No timeline: The Constitutional Amendment fails to set a date by which the Legislature would need to act or specify what would happen if the Legislature fails to pass legislation dealing with this issue.

The Michigan Chamber of Commerce supports adhering to the following principles when debating state or federal proposals to modify our health care delivery system.

New health care policy should:

• Maintain an employer’s right to choose to provide health care coverage for their employees and should not penalize job providers who choose not to.
• Not increase taxes on Michigan job providers.
• Allow greater flexibility in plan design and encourage personal responsibility for managing health care costs and wellness.
• Foster competition through the private marketplace.
• Not grow the size of government.
• Identify ways to reduce health care costs.
• Provide a genuine opportunity for increasing the number of individuals with health benefit coverage. 
• Not add any new mandated benefits.
• Encourage individuals to purchase health care coverage.
• Be based upon free market principles and sound actuarial practices rather than artificial rate restrictions.
• Aim to increase choice by fostering plan competition and availability.
• Reduce cost-shifting from government to private payers and reward provider efficiency and quality.
• Ensure meaningful legal reform is an integral part of health care reform legislation.

Background

The United States Congress has spent the summer of 2009 trying to broker a deal to reform the nation’s health care system. There are many problems with the current system but the number one issue for employers purchasing health care coverage for their employees is affordability.

The Michigan Chamber of Commerce is dedicated to improving our nation’s and state’s health care system, especially in terms of lowering costs, improving the quality of care and making sure every American has access to affordable coverage. This could include giving consumers timely information on the cost and quality of their care, providing them with a broad array of health plan options, including plans without government mandated benefits, and rewarding both providers and consumers for positive health outcomes that will reduce long-term costs. 

We believe that responsible and constructive modifications to our health care system can be achieved and enacted in 2009; however, we believe that the legislation currently under consideration in the U.S. Congress would not improve the system, but jeopardize the parts that currently work.

In particular, we are opposed to proposals that would mandate that employers either provide health insurance or pay huge fines or payroll taxes to the government. This “pay or play” mandate is especially harmful because employers are also required to pay the majority of employee premiums. Even with some exemptions, this provision would kill many jobs. We believe market forces and employer autonomy should determine what benefits employers provide, rather than government.

The Michigan Chamber is also opposed to the creation of a new government-run insurance plan to “compete” with private insurance companies. This is a step in the wrong direction because the government will never be a fair competitor. Employers currently suffer a significant cost-shift from existing public programs, and the program described in the House legislation would significantly increase costs for every American who purchases private insurance. Because of these increased costs, the Lewin Group, an independent health care and human services policy research and management consulting firm, estimates that 130 million people would move from private to public insurance, which could lead to a government-controlled single-payer system.

Finally, we are opposed to imposing new tax burdens on individuals and businesses to pay for changing the current system. The implementation of new taxes and fees on businesses and/or individuals would be dramatically counterproductive, especially during this economic downturn. In particular, the taxation of employer-sponsored health benefits would lead to a reduction in benefits offered to employees, drive up Michigan’s unemployment rate and rob businesses of their valuable resources.

In addition to federal health care proposals, the Michigan Legislature is also considering several ideas that would impact Michigan’s individual health insurance market as well as employer-sponsored health insurance. There are several provisions in both the House and Senate plans that the Michigan Chamber could support, such as regulating the individual market by imposing a six-month, pre-existing condition waiting period and establishing recession rules for all carriers.  However, just as with the Congressional plans, the Michigan Chamber has several key concerns with the Michigan House and Senate plans. 

Our primary concern with the Michigan Senate’s plan relates to the creation a new governmental entity responsible for facilitating the availability, choice and subsidized purchase of eligible health coverage plans to uninsured individuals. The subsidized plan would be paid for by a “surcharge” of up to 1.8 percent on all paid claims, a payment in lieu of taxes (local and MBT) by Blue Cross and an increase in the Quality Assurance Assessment Program (QAAP) tax on hospitals.  We are concerned that the surcharge will result in a tax shift from insurers and third party administrators to job providers purchasing health insurance for their employees, which could cause some employers to drop health insurance coverage altogether. In addition, we are concerned that the proposal would grow the size of government at a time when the State of Michigan can least afford to do so.

The Michigan Chamber’s primary concern with the Michigan House’s plan also relates to the creation of prioritized subsidies for the poor uninsured.  hese subsidies would be paid for by a yet-to-be-determined assessment amount on all non-profit health insurers, including Blue Cross Blue Shield of Michigan (BCBSM) and Health Maintenance Organizations (HMOs). We are concerned that the proposal would increase taxes on some health insurers, which could result in a tax shift to private payers, including employers purchasing health insurance for their employees.  This could put many workers in jeopardy of losing this coverage. As with the Senate plan, we are also concerned that this proposal grows the size of government by expanding current entitlement programs.