5 Michigan cities voted to create ‘health action’ boards. Now what?

Amid growing concerns over medical costs, voters in five Michigan cities last week approved measures to create new citizen-led boards that will recommend ways to lower costs and improve healthcare policies.

How the boards will function is not clear, nor is the source of funding for the successful ballot campaigns. Liberal “dark money” groups spent nearly $3 million on the initiatives, which were spread across two toss-up congressional districts represented by Republicans who lost their reelection bids.

But with healthcare costs top of mind for many, voters agreed to establish “citizens’ advisory health action” committees by wide margins in Benton Harbor ( 80% approval ), Lansing ( 66% approval ), East Lansing ( 69% approval ), Kalamazoo ( 69% approval ) and Portage ( 55% approval ).

Now, it’s up to local governments in those cities to set up the boards, prompting fears of additional costs and uncertain outcomes.

“If the voters want it, then we’ll set up a committee and we’ll do it,” Lansing Mayor Andy Schor told Bridge Michigan ahead of the election, expressing ambivalence and acknowledging the proposals made a political point.

The cities will be limited in how much they can impact a sprawling national healthcare system with mind-numbing complexities, often opaque financing and Medicaid eligibility changes that are expected to reduce coverage and cost providers millions of dollars.

But the new committees will be able to advise officials whose policies could support local health providers in ways that drive down costs, said Ryan Cohn, a spokesperson for City Action Michigan , the nonprofit driving the effort .

“Voters sent a clear message,” said Cohn, who works for a Florida-based public relations firm, Sachs Media . “They want action on healthcare costs, and they’re done waiting for Congress to deliver it.”

A late-October poll of Michigan voters showed high costs were a top concern, with health insurance or medical costs the primary driver.

The local proposals amended city charters to create seven- or eight-member committees to:

City councils then must hold public hearings by Oct. 15 of the same year for public discussion on the action plan. Advisory committee members will not be paid for their efforts, but must have necessary “research, analytical and community engagement skills,” according to the new rules.

Some local officials have called the effort misguided.

In October, the Kalamazoo City Commission passed a resolution unanimously opposing the local ballot measure. In public meetings , Mayor David Anderson expressed concerns about the ongoing financial burden organizing and running health advisory committees might impose on taxpayers.

“Who’s gonna pay for all this work going forward in perpetuity? City residents,” Anderson said. “The cost of this will end up being a reduction in resources for something else that we might care a lot about.”

Kalamazoo Commissioner Chris Praedel criticized the use of dark money to push the proposal, warning that it was “critically important for the public to think through how this sets a precedent or how this could impact things in a very dark, mischievous way.”

It’s unclear how much the initiative will cost cities going forward. Committee members aren’t paid, although they can be compensated for costs, according to ballot language.

“I would not envision it would be a lot,” said Alex Little, city manager in Benton Harbor.

The proposals were notable for the way that they intertwined policy and electoral advocacy — the amendments were only proposed in largely Democratic cities within battleground congressional districts — and campaign advertising prominently attacked the Republican incumbents.

Those lawmakers, US Reps. Tom Barrett and Bill Huizenga, were both unseated in close races in the Nov. 3 election. Democrats Will Lawrence and Sean McCann will replace them in Congress, respectively.

Critics suggested the petition drives used to put the proposals on local ballots were designed to collect voter data and spread negative information about the incumbents.

In an election where Democrats saw sweeping gains, approval rates for the ballot proposals in the five liberal-leaning cities generally lagged behind support for major Democratic candidates like Gov.-elect Jocelyn Benson.

Chokwe Pitchford, a Berrien County commissioner whose nonprofit was paid by City Action Michigan to build support for the proposals, dismissed concerns that the initiative could set a precedent where municipal government itself becomes a platform for political advocacy.

“Everyone has access to these tools, and if the other side wants to push a ballot proposal about the Second Amendment or about pro-life policies — if the voters vote for it, that’s democracy,” Pitchford said in an interview.

The only representative of the City Action Michigan (formerly Community Action Michigan) that the campaign had not reported paying as of mid-October, Texas Charter Township trustee Barb Hammond, declined repeated requests for an interview with Bridge.

Local officials are now attempting to figure out how the new committees will work and what their responsibilities are.

Municipal advisory boards or committees tend to focus on specific city operations like parks, libraries or transit systems, said Little, the Benton Harbor city manager. But “this is more of a study group to understand price and services for healthcare,” he said.

Benton Harbor faces another challenge, he said: The city’s hospital closed 40 years ago, and the city — one where the median income is just above $31,000 and among the lowest in the state — may not have enough residents with healthcare and financing backgrounds to serve on the board.

Moreover, he and others said it might seem like local governments can do little to shape healthcare policy. Benton Harbor’s public health initiatives are run through the county health department, for example.

And decisions in a national healthcare system with its “infinite complexity” are mostly guided by federal and state policy, said Scott Greer , a University of Michigan professor who researches the ways in which political systems operate and shape health policy decisions.

Still, the biennial reports that the committees produce will force “hyper-local” conversations that otherwise might not happen, Greer said.

A community might explore how much emergency care is provided to homeless people, and therefore shift policy to extend more routine care to the homeless as a way to keep chronic conditions in check, Greer suggested as an example. That could be a cost saving for the system as those patients then rely less on expensive emergency room care.

Benton Harbor, meanwhile, is facing hundreds of thousands of dollars in extra costs to pay for ambulance services because so many local patients are uninsured, said Little, the city manager. Perhaps an advisory committee focused on healthcare can find a solution, he mused.

Cohn, at City Action Michigan, said the advisory committees can also offer collective voices that can reach Lansing.

Pitchford, in Berrien County, argued the reports can be tailored to “the preconditions of your community.”

“You might have an infant mortality crisis, you may have an obesity crisis, you may have pollution in the water, pollution in the air,” he said. “How do we gather all of that information, put it into something that is actionable, and take that to Lansing and to Washington, (DC) so that citizens can lobby their government on behalf of the changes to healthcare that they believe in?”

Spokespersons for East Lansing and Portage said city officials now will review next steps.

Through mid-October, the ballot committee for City Action Michigan reported receiving $2.8 million in donations, exclusively from dark-money nonprofits from outside Michigan not required to disclose their donors.

They include American Opportunity Action, Cityscope, Global Impact Social Welfare Fund and Global Impact Ventures — all of which have been known to channel funding to liberal political initiatives while masking donor identities.

Much of the funding was spent on ads supporting the proposals and to pay canvassers who collected signatures to get the initiatives onto local ballots.

City Action Michigan also disclosed giving $100,000 to Pitchford’s 501(c)(4) nonprofit, Berrien Forward.

Pitchford said the money, reported as a grant, was used to pay 17 canvassers to promote the proposals in Benton Harbor and Kalamazoo.

“These were older Black women from churches, young people who were getting involved with the election process for the first time, who got trained on knocking doors, and we used that funding to invest in the election,” he said.

It’s a “fair criticism” to note that neither he nor the voters know where the money came from, Pitchford acknowledged.

He said he makes “value-based assessments” when groups approach him to work on their issues. “No funder, no group has ever asked me to do anything that I don’t believe in,” Pitchford added.

This story was originally published by Bridge Michigan and distributed through a partnership with The Associated Press.