MONROE - Monroe Mercy Memorial Hospital has weathered its share of financial woes, said Chief Executive Officer Richard Hiltz.
The hospital could use additional funding for its emergency room and extra dollars would go a long way to help pay medical care costs for the uninsured or underinsured - many of whom come to the hospital through the ER doors.
All financial concerns could be alleviated, Mr. Hiltz said, if the nonprofit hospital receives its fair share of funding from the tobacco settlement money awarded to states four years ago.
Michigan voters will be faced with four proposals on the Nov. 5 ballot. The ballot issue known as Proposal 4 - initiated by the Citizens for a Healthy Michigan Coalition - asks voters to constitutionally appropriate money from the tobacco lawsuit settlement toward health care, research, and smoking prevention programs.
Proponents of the proposal say these programs are where the money should have gone all along. The opposition says approval of Proposal 4 will tie the hands of future lawmakers and shut down programs such as the Michigan Merit scholarships, which go to some high school students.
“The coalition took the avenue of the ballot proposal because Michigan is one of only three states that didn't designate tobacco settlement money for health care,” Mr. Hiltz said. “We would like to see the funds used for the purpose for which they were designated, to help people with tobacco-related illnesses, especially those people who are either underinsured or don't have insurance at all.”
In 1998, the tobacco industry agreed to pay 46 states more than $206 billion over a 25-year period to offset the costs that health-care providers and states spent administering health-care treatment to smokers. Michigan's share is $8 billion.
To date, Michigan has spent the majority of its more than $300 million-a-year allotment providing $2,500 scholarships to Michigan high school students. Terry Stanton, spokesman for the Michigan Department of Treasury said that scholarships make up about $115 million of the funding. The rest is divided up between education-related programs, senior prescription drug programs, subsidies for private and university health research, and to offset gaps in the general fund.
In Ohio, about 35 percent of the settlement money is being spent on tobacco prevention while the remaining $260 million was recently diverted to help fix the state's short-term budget woes.
Citizens for a Healthy Michigan Coalition, a group made up of health and hospital organizations, wants Michigan to commit 90 percent of its settlement money to nonprofit hospitals, licensed nursing homes, licensed hospices, and a variety of tobacco prevention programs. About one-third of the funds, or $42.9 million, would be used to fund the elder prescription drug program.
Legislators wouldn't be able to touch the funds or divert it elsewhere.
“Some of the programs that they created are good, but our position is that this isn't what the money should be used for,” said Roger Martin of Citizens for a Healthy Michigan Coalition. Statewide “about 300 adults die weekly because of smoking-related diseases, and we just don't have a comprehensive tobacco-help program here. We just don't.”
According to the Campaign for Tobacco Free Kids, Michigan should be spending between $54 million and $154 million annually on tobacco prevention - figures the group credits to the Centers for Disease Control.
“What this would do is to spend some serious money toward tobacco prevention programs, the first comprehensive statewide program in the state's history,” said the campaign's assistant Director of Advocacy Peter Fisher.
“It was up to the prerogative of the states how to spend that money. We believe that there's a moral prerogative here to use some of that money, we're not saying all, to address tobacco prevention issues.”
Opposition to the proposal is widespread and crosses party lines. Among those that have pledged to oppose the proposal are the Area Agencies on Aging Association of Michigan, Michigan Education Association, and both gubernatorial candidates.
People Protecting Kids and the Constitution is the committee that formed in opposition to the proposal. Co-Chairmen State Sen. John Schwartz, (R., Battle Creek) and former Attorney General Frank Kelley - one a Republican, the other a Democrat - have criticized the proposal because they said it would disperse millions of dollars to private groups and organizations without any public accountability.
“There's no question in my mind that this is the wrong thing for the state,” Senator Schwartz said. “This is the absolute worst by far ballot proposal that I've ever seen.”
State Sen. Bev Hammerstrom, (R., Temperance) agrees. An opponent of the proposal, Ms. Hammerstrom said the state spends more than $30 million on tobacco prevention programs. The money, she added, comes from other sources.
The senator adds the campaign in favor of Proposal 4 is misleading because the intent of the settlement was to reimburse states for health care costs that had been already been paid out.
There were no restrictions on how the money could be used in the future, she said.
The proposal's effect on the state budget was such a concern for Gov. John Engler that he vetoed the state revenue sharing - money that is dolled out to local communities to bolster their general funds.
State lawmakers overrode the veto, despite their own budgetary concerns.
State Rep. Doug Spade, (D., Adrian) said while he supports the stop smoking campaign, he too has concerns about constitutionally tying the money to certain programs.
“There are other options to this proposal,” he said. “We will have a lot of new people in the legislature next year and we'll have a new governor. That will create a whole different perspective about the budget.”
Although likely the most controversial, Proposal 4 isn't the only issue facing Michigan voters.
Residents will also cast votes on whether to approve a referendum to amend Michigan election law and a proposal to grant state classified employees the constitutional right to collective bargaining with binding arbitration.
A final proposal, known as Proposal 2, asks voters to “authorize bonds for sewage treatment projects, storm water projects, and water pollution projects” - issues well known in southeast Michigan.
Adrian and Blissfield are among many Michigan communities struggling with problems associated with combined sanitary and storm sewers. If approved, the proposal offers help in the form of a $1 billion bond issue.
Recognizing the plight of older communities, state lawmakers are proposing to borrow up to $1 billion to help finance projects to prevent the discharge of untreated sewage into the state's waterways.