Healthcare Should Be Affordable and Reliable
A public healthcare plan that lowers costs, guarantees coverage, and strengthens community care across Michigan.
Healthcare should not depend on luck, job status, or the ability to navigate complex insurance systems.
In Michigan today, families face rising premiums, unpredictable medical bills, and prescription costs that increase faster than wages. Even people who work full time and have insurance often delay care because they cannot afford to use it.
The MI-Care Plan would create a simple, reliable public healthcare system that guarantees coverage for every resident while preserving choice of doctors and hospitals.
By reducing administrative waste, negotiating fair drug prices, and stabilizing hospital funding, Michigan can lower costs for families, strengthen local healthcare systems, and build a healthier, more economically secure state.
Healthcare reform is not just about coverage — it is about financial stability, workforce strength, and long-term economic growth.
Michigan can build a better system.
Rising Healthcare Costs
Healthcare costs are one of the biggest financial pressures facing Michigan families.
Even people with insurance struggle with high deductibles, rising premiums, and prescription prices that increase faster than wages.
Small businesses face growing costs to provide employee coverage, while rural hospitals operate under constant financial strain.
When people delay care because they cannot afford it, small health problems become serious medical emergencies.
Emergency Room Visit Cost
Average ER visit in the United States:
$2,600+
Unexpected medical emergencies can leave families with thousands of dollars in bills — even when they have insurance.
Childbirth Hospital Cost
Average hospital cost for childbirth in the United States:
Vaginal delivery: $13,000+
Cesarean delivery: $22,000+
For many families, the cost of having a child can mean thousands of dollars in medical bills even with insurance coverage.
For many Michigan families, one medical emergency can mean months or years of debt.
The MI-Care Plan
Michigan can create a state public healthcare program that guarantees affordable care for every resident.
MI-Care would operate as a statewide public health plan available to all Michigan residents, ensuring that coverage is reliable, simple, and independent of employment status.
Under MI-Care, patients would continue to choose their doctors and hospitals while gaining the security of universal coverage.
Most importantly, MI-Care would eliminate financial barriers to basic healthcare.
No Michigan resident should delay care, skip medication, or avoid the doctor because of cost.
The goal is simple: universal coverage, lower costs, and healthcare people can actually afford to use.
MI-Care would guarantee $0 cost at the point of service for medically necessary care and prescriptions — ensuring that no Michigan resident is forced to choose between their health and their finances.
The Policy
How MI-Care Works
Universal Coverage
Every Michigan resident would have access to healthcare coverage through MI-Care.
Coverage would no longer depend on employment, income level, or navigating complex private insurance networks.
No one should go without care because of cost or gaps in coverage.
Lower Costs
MI-Care would reduce healthcare costs by:
• negotiating prescription drug prices
• simplifying insurance administration
• reducing billing complexity for providers
• expanding preventive care to avoid costly emergencies
Lower administrative costs and negotiated prices would allow the system to deliver better care while controlling long-term healthcare spending.
Choice of Providers
Patients would continue to choose their doctors, hospitals, and healthcare providers.
MI-Care is designed to expand access to care, not restrict it.
Private providers, hospitals, and clinics would remain central to Michigan’s healthcare system.
Support for Hospitals and Providers
Hospitals across Michigan — particularly rural hospitals — face growing financial pressure due to uncompensated care and unstable reimbursement systems.
MI-Care would stabilize healthcare funding by ensuring that:
• more patients have reliable coverage
• providers receive consistent reimbursement
• hospitals are not overwhelmed by unpaid care
This helps keep hospitals open and healthcare jobs in Michigan communities.
Current System
• high deductibles
• complex insurance networks
• administrative overhead
• unpredictable medical bills
MI-Care System
• universal coverage
• simplified administration
• negotiated drug prices
• $0 cost at point of service
Public healthcare systems that guarantee universal access while controlling long-term costs are already operating successfully across the United States and around the world.
States use public employee health plans, Medicaid managed care systems, and prescription purchasing collaboratives to negotiate prices and coordinate coverage at scale.
Countries with simplified coverage systems consistently achieve lower administrative costs and better health outcomes.
Michigan is well positioned to implement a modern public coverage model because the state already has:
• major hospital networks
• strong community health systems
• a large medical workforce
• advanced health data infrastructure
• experience managing large public insurance programs
MI-Care builds on these existing strengths rather than replacing them.
Built on Proven Healthcare Models
Build a statewide public coverage system based on proven models that deliver universal access and lower administrative costs.
The Policy
Reducing Administrative Waste
Administrative costs in the U.S. healthcare system account for nearly twice the share seen in many other developed healthcare systems.
Hospitals and providers must navigate dozens of insurance plans, billing systems, and approval processes that add cost without improving care.
MI-Care would simplify healthcare administration by operating a unified public coverage system.
Reducing administrative complexity lowers costs for providers, insurers, and patients while allowing healthcare professionals to focus on delivering care.
By simplifying insurance administration and negotiating prices statewide, MI-Care would reduce healthcare system overhead and redirect savings toward patient care.
The Policy
Lower Costs for Families
MI-Care would make healthcare more affordable for Michigan families by simplifying the system and removing financial barriers to care.
Instead of navigating high deductibles, surprise bills, and rising insurance premiums, residents would have reliable coverage they can actually use.
Under MI-Care, families would save money because:
• there are no deductibles or copays for essential care
• prescription medications are covered
• preventive care is fully accessible
• administrative costs and insurance overhead are reduced
Families would spend less on premiums and out-of-pocket expenses while receiving more reliable healthcare coverage.
Under MI-Care, Michigan residents would pay nothing at the point of service when visiting a doctor, receiving treatment, or filling a prescription.
The Policy
Hospitals across Michigan — especially rural hospitals — face growing financial pressure from uncompensated care, rising operating costs, and unstable insurance reimbursement.
MI-Care would establish predictable statewide reimbursement standards so hospitals and providers are fairly compensated for care.
When more patients are insured and billing systems are simplified, hospitals can focus on providing care rather than managing unpaid bills and complex insurance paperwork.
MI-Care would help ensure that:
• more patients have reliable coverage
• providers receive predictable reimbursement
• hospitals are not overwhelmed by uncompensated care
This stability helps keep hospitals open, protects healthcare jobs, and strengthens Michigan’s medical workforce.
Supporting Hospitals and Providers
MI-Care would ensure hospitals and providers receive reliable reimbursement for patient care while reducing uncompensated treatment costs across the healthcare system.
The Policy
Strengthening Community Health Systems
A strong healthcare system depends on accessible local care.
Community health centers provide essential services in underserved neighborhoods and rural communities, offering preventive care, mental health treatment, addiction services, and primary care close to home.
MI-Care would expand support for community health clinics to ensure more residents can receive care before small health issues become serious medical emergencies.
By strengthening local clinics and preventive care programs, Michigan can:
• reduce emergency room visits
• improve long-term health outcomes
• expand mental health and addiction services
• bring primary care closer to where people live
Investing in community health systems helps patients receive care earlier, lowers overall healthcare costs, and strengthens public health across the state.
MI-Care would expand support for community health centers and preventive care programs to improve healthcare access in underserved and rural communities.
The Policy
Community Veterinary Clinics and Pet Care
Pets are family members in millions of Michigan households.
But when families face financial hardship — especially during economic downturns — pet surrender rates increase dramatically as households struggle to afford veterinary care.
No one should have to choose between paying rent, filling a prescription, and caring for a beloved pet.
As part of MI-Care’s community health infrastructure, Michigan would support community veterinary clinics that provide basic veterinary care for pets.
These clinics could provide:
• vaccinations
• preventative care
• routine treatment
• emergency assistance services
• essential veterinary medications
Keeping pets healthy helps keep families together and reduces pressure on animal shelters across Michigan communities.
MI-Care would support community veterinary clinics that provide $0 point-of-service basic veterinary care, emergency services, and essential medications for pets.
The Policy
Optional Pet Health Coverage
In addition to community veterinary clinics, families could choose to enroll their pets in affordable statewide pet health coverage plans through MI-Care.
These voluntary plans would help cover more complex veterinary care that goes beyond routine services.
Coverage could include:
• specialized veterinary medications
• diagnostic testing and imaging
• surgeries and advanced procedures
• long-term treatment for chronic conditions
By pooling risk across the state, MI-Care could offer pet health coverage at lower costs than most private pet insurance plans, making advanced veterinary care more accessible.
Pets play an important role in emotional wellbeing, family stability, and mental health.
Supporting responsible pet care strengthens families, protects animal welfare, and helps keep communities together.
MI-Care would allow families to opt into affordable statewide pet health coverage plans for advanced veterinary treatment and specialized care.
The Policy
Medical Debt Relief Program and a Fresh Start
Millions of Americans carry medical debt from unexpected illnesses, injuries, or emergency care.
Even people with insurance can face overwhelming bills.
Medical debt damages credit, prevents families from buying homes, and keeps people trapped financially long after they recover.
Michigan can help provide a fresh start.
The state can partner with nonprofit organizations to purchase medical debt on the secondary market at steep discounts and forgive it entirely.
Because medical debt is often sold for pennies on the dollar, a modest public investment can eliminate hundreds of millions of dollars in debt for Michigan families.
This program would focus on helping:
• low-income households
• families facing catastrophic medical bills
• residents with long-standing medical debt
Combined with MI-Care’s universal coverage, this program would ensure families are not burdened by medical bills from the past while building a healthcare system that prevents those debts from happening again.
Healthcare reform should not only change the future — it should help families move forward today.
Michigan would create a Medical Debt Relief Program to purchase and eliminate medical debt for eligible residents while MI-Care prevents new debt from accumulating.
The Policy
Healthcare reform should not only fix the system going forward — it should also give families burdened by past medical bills a chance to start over.
Affordable Medicines & Public Supply Stability
Lower prescription drug costs are essential to making universal healthcare work.
MI-Care would be supported by MI-Meds: Michigan Essential Medicines Access Guarantee ensuring that residents can obtain widely used life-saving medications at low or no cost.
To deliver this reliably, Michigan would pursue a Public Pharmaceutical Manufacturing Strategy focused on producing high-priority generic medicines when private markets fail to provide stable or affordable supply.
This approach would:
reduce long-term healthcare spending
protect hospitals and patients from shortages
strengthen supply chain resilience
support new advanced manufacturing jobs
By combining smarter purchasing, price negotiation, and targeted public production, Michigan can make healthcare coverage more affordable while improving public health outcomes.
Learn more about MI-Meds→, the program that will help make this guarantee possible.
MI-Meds
Statewide negotiated purchasing and public manufacturing capacity to ensure critical medications are available with no cost at the point of service.
The Policy
Benefits for Michigan
MI-Care would help:
families struggling with medical bills
small businesses that cannot afford employee coverage
rural hospitals facing closure
workers who lose coverage when they change jobs
communities that need stronger healthcare infrastructure
Healthcare would become portable, predictable, and affordable for every Michigan resident.
What MI-Care Could Look Like for a Michigan Family
Consider a Michigan family today.
A parent works full time but faces high deductibles and rising premiums. Prescription medication for a child costs hundreds of dollars each month.
If that parent loses their job, the family may lose coverage entirely.
Under MI-Care, that family would have stable coverage regardless of employment.
They could visit their doctor, fill prescriptions, and receive preventative care without worrying about losing insurance.
Community health centers would provide accessible care close to home.
If they owned a pet, community veterinary clinics would help ensure their animal receives basic care.
Healthcare would become stable, predictable, and affordable.
Michigan Already Pays for Healthcare
Michigan families, employers, and government programs already spend enormous amounts on healthcare through:
private insurance premiums
employer healthcare plans
Medicare and Medicaid
out-of-pocket medical bills
hospital uncompensated care
prescription drug costs
The problem is that these costs are fragmented, inefficient, and inflated by administrative overhead.
Michigan already spends enough to provide quality healthcare for everyone — the challenge is organizing those resources into a system that works.
MI-Care would reorganize this spending into a simpler system that reduces waste and lowers costs.
Economic & Workforce Benefits of MI-Care
Healthcare costs are one of the largest barriers to economic growth in Michigan.
MI-Care would transform healthcare from a cost burden into a competitive advantage.
Lower Costs for Employers and Small Businesses
Today many Michigan businesses struggle with rising premiums that:
discourage hiring
reduce wage growth
create uncertainty during economic downturns
MI-Care would replace fragmented insurance premiums with a stable, predictable financing structure, allowing:
lower total benefit costs for most firms
improved business planning certainty
stronger competitiveness for Michigan manufacturing and service industries
Stronger Workforce Mobility
Workers often remain in jobs primarily to maintain health coverage.
By guaranteeing universal coverage:
workers can pursue retraining or entrepreneurship
layoffs become less economically destabilizing
mid-career transitions become more feasible
This supports a more dynamic and innovative labor market.
Rural Economic Stabilization
Hospital closures and physician shortages are major threats to rural communities.
MI-Care would:
stabilize hospital funding through predictable reimbursement
expand community health centers
support rural provider recruitment incentives
This helps protect local economies where healthcare is often a major employer.
Wage Growth and Household Stability
When employers spend less on healthcare inflation, more resources can support:
wage increases
retirement benefits
workforce training investments
Households benefit from:
reduced medical debt risk
predictable financial planning
increased consumer spending capacity
How MI-Care Is Paid For
Michigan already spends billions each year on healthcare through a mix of public programs, private insurance, employer plans, and out-of-pocket costs.
Today those dollars flow through a fragmented system with high administrative overhead and inflated pricing.
MI-Care would reorganize this spending into a simpler public system that reduces waste and negotiates better prices for care and medications.
Funding for MI-Care would come from a combination of:
• consolidating existing public healthcare spending
• negotiating lower prescription drug prices
• reducing insurance administrative costs
• employer and employee contributions that replace private insurance premiums
In addition, MI-Care would be part of a broader Michigan Reform Plan that modernizes the state’s tax system to better support public services.
This includes fair tax reforms that ask the wealthiest households to contribute more, ensuring that Michigan can invest in healthcare, housing, education, and infrastructure.
A modern healthcare system requires a modern tax system where the wealthiest households contribute their fair share to support the wellbeing of the entire community.
For most families and small businesses, the cost of healthcare would decrease, because expensive private premiums and unpredictable medical bills would be replaced with a simpler and more stable system.
The goal is not to increase healthcare spending — it is to spend healthcare dollars more efficiently while ensuring everyone receives care.
Transitioning to MI-Care
Michigan will implement MI-Care through a phased transition designed to minimize disruption for patients, providers, and employers.
Early phases will focus on expanding eligibility through a public option structure, reducing prescription costs, and simplifying administrative requirements.
As enrollment grows, the state will integrate existing Medicaid populations, offer employer participation pathways, and expand benefit coverage toward universal eligibility.
Private insurance plans would continue to operate during the transition period while residents gain the option to enroll in MI-Care.
This approach ensures continuity of care while building a stable long-term coverage system.
How MI-Care Will Be Governed
MI-Care will be administered through a transparent public structure designed to protect patients, maintain provider stability, and control long-term costs.
The program will be overseen by a new Michigan Health Assurance Authority (MHAA) — an independent public entity responsible for financing, contracting, and performance oversight.
Core Governance Structure
Michigan Health Assurance Authority
Responsible for:
negotiating statewide provider reimbursement frameworks
administering resident enrollment and coverage eligibility
managing claims payment and care coordination systems
overseeing pharmaceutical purchasing and price negotiation
publishing public performance and cost transparency dashboards
Independent Oversight Board
MI-Care will be guided by a multi-stakeholder board including:
physicians and nurses
hospital system representatives
patient advocates
small business representatives
public finance experts
state officials
This structure ensures decisions balance:
cost control
provider sustainability
access and quality
economic competitiveness
Regional Health Stability Councils
To ensure local responsiveness, Michigan will establish regional health councils that:
monitor rural hospital viability
coordinate workforce shortages
guide community clinic expansion
advise on regional infrastructure investments
Accountability & Transparency Measures
MI-Care will include some of the strongest accountability rules in the country:
annual public reporting on cost growth targets
patient access benchmarks
wait time and provider network adequacy standards
fraud prevention and administrative efficiency audits
legislative review triggers if spending exceeds targets
The goal is predictable public stewardship — not unchecked bureaucracy.
Why State Leadership Matters
Federal healthcare reform has stalled for decades.
States can lead.
Michigan has the resources, hospitals, and workforce needed to build a system that works.
By acting at the state level, Michigan can demonstrate that universal healthcare can reduce costs while improving care.
Healthcare should not depend on where you work, how much you earn, or which insurance company you have.
And no family should have to give up a pet because they cannot afford care.
MI-Care would guarantee healthcare for people, strengthen community clinics, and support the wellbeing of Michigan families.
Legislative Package
MI-Care would be enacted through a coordinated legislative package designed to deliver visible household relief early while building the long-term structure for universal care.
The first phase would focus on the reforms people can feel fastest:
creating the MI-Care governing authority
establishing the $0 point-of-service coverage standard for medically necessary care
lowering prescription drug costs through statewide purchasing authority
relieving medical debt
stabilizing rural hospitals and providers
expanding community clinics and care access
growing the healthcare workforce
launching first-wave pet coverage because pets are family
creating public transparency and performance reporting from the start
Later legislation would build on that foundation by simplifying administration, controlling long-term cost growth, integrating public programs, and creating employer transition pathways.
Start with a strong first-wave health package that lowers costs, expands access, and builds the foundation for universal human and pet care.
The Policy
MI-Care Implementation Timeline
Michigan will implement MI-Care in phases so residents see real savings early while the state builds the long-term system needed for universal human and pet coverage.
The first phase focuses on the biggest immediate wins: creating the MI-Care authority, launching the $0 point-of-service standard for covered medically necessary care, lowering prescription costs, reducing medical debt, stabilizing providers, expanding clinics, and launching pet coverage.
Later phases focus on making the system easier to use, integrating public programs, expanding portability, and reducing dependence on job-based coverage.
The goal is simple: deliver household relief fast, then build a stronger and more stable public healthcare system over time.
Phase 1 — Launch Household Health Security
Years 1–2
Michigan begins with the fastest and most visible improvements:
create the Michigan Health Assurance Authority
launch first-wave $0 point-of-service human coverage
lower prescription costs through statewide purchasing
reduce medical debt burdens
stabilize rural hospitals and providers
expand clinics and local care access
begin healthcare workforce expansion
launch $0 point-of-service pet coverage
What people feel first:
going to the doctor without worrying about cost
lower prescription costs
relief from medical debt pressure
stronger local care access
$0 veterinary care for pets
Phase 2 — Expand Capacity and Simplify the System
Years 2–4
Michigan builds the systems needed to make MI-Care easier to use and more durable:
expand provider, pharmacy, and veterinary participation
simplify billing, claims, and reimbursement
strengthen medicine distribution and preventive care access
improve network reliability and continuity of care
What this adds:
easier enrollment and fewer confusing gaps
more participating providers
stronger continuity of care for people and pets
Phase 3 — Build Long-Term Universal Stability
Years 4+
Michigan then expands MI-Care into a more fully integrated long-term public coverage system:
align public programs over time
expand portability across life and job changes
create employer transition pathways
strengthen long-term cost discipline and quality review
Long-term result:
MI-Care becomes a stable household health security system that treats both healthcare and pet care as part of family affordability.
Launch the biggest household health savings first, then build MI-Care into a long-term universal system.
The Policy
How MI-Care Fits into the Michigan Reform Plan
MI-Care is part of the broader Michigan Reform Plan to lower costs, strengthen public systems, and make everyday life more secure for working families.
It works alongside MI-Meds, housing policy, education investment, and industrial renewal to reduce long-term household pressure and build a stronger economic foundation.
When healthcare is affordable and easy to use, families are more stable, workers have more freedom to change jobs or start businesses, and employers face less pressure from rising benefit costs.
In the Michigan Reform Plan, MI-Care is not just a healthcare policy. It is a cost-of-living reform, a workforce reform, and a family security reform.
MI-Care lowers household cost pressure and makes the broader Michigan Reform Plan easier to sustain.
The Policy
Policy Details
For readers interested in the full legislative framework, the proposed statutory language for this policy is available below.
These documents outline how the proposal could be implemented in Michigan law and provide a more detailed view of the policy design.
The policy frameworks will continue to be refined with input from policy experts, healthcare providers, educators, and community leaders across Michigan.
Healthcare Should Be a Guarantee — Not a Financial Risk
MI-Care would guarantee healthcare access, lower costs, and strengthen community health systems across Michigan.
By simplifying coverage and reducing administrative waste, Michigan can build a healthcare system that works for families, patients, and providers.
Learn More About the Michigan Reform Plan