Episode 327- How Michigan Hospitals Stay United Under Pressure. with Brian Peters

Medicaid decisions made in a capitol building can land in a hospital waiting room fast and the ripple effects are bigger than most people realize. From the 2026 Mackinac Policy Conference, we sit down with Brian Peters, CEO of the Michigan Health and Hospital Association, to talk about what Michigan hospitals are facing right now and what actually helps patients keep access to care.

We start with the MHA’s “convener” role and why it still matters even as healthcare consolidation creates bigger systems and sharper competition. Brian explains how Michigan maintains something rare: 100% hospital and health system membership, which changes the stakes when we speak with lawmakers, regulators, and the media. When we can show a united front, we can focus on solutions like quality improvement, shared learning, and practical public policy that supports communities across rural and urban Michigan.

Then we get into Medicaid funding, Medicaid eligibility, and the administrative hurdles that can quietly knock eligible people off coverage. Brian lays out the tension between a consistent national message in Washington and the reality of 50 different state Medicaid programs, including differences in Medicaid expansion and provider tax approaches. We also zoom out on healthcare affordability after COVID, why finger pointing will not reduce costs, and how technology and AI could improve care delivery if we build systems people can actually use. Brian closes with an urgent message about the rise of workplace violence in healthcare and why respect for caregivers is essential to recruiting and retaining a strong bedside workforce.

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Transcript

Here's the cleaned-up transcript. I fixed spelling, duplicated words, subject-verb agreement, a few misplaced speaker breaks (where a sentence had clearly been split mid-thought), and light punctuation — while keeping every idea, argument, and turn of phrase as close to the original as possible.

Richard Helppie
Welcome to the podcast on behalf of the Michigan Health and Hospital Association. I'm your host, Rich Helppie of the Common Bridge. Look us up at Substack or at any of your podcast outlets, and we have someone today with us who knows well everything there is to know about the Michigan Health and Hospital Association, because he is the chief executive officer of the Michigan Health and Hospital Association — my dear friend and industry expert colleague, Mr. Brian Peters. Brian, great to see you.

Brian Peters
Rich, it's always a pleasure to see you. You've been an amazing leader and partner with the MHA for so many years, and it's great to be together here on the island.

Richard Helppie
It sure is. It's been a long association, and the island is always a special place — a special place for convening — and that's one of the things the MHA is best known for: being a convener.

Brian Peters
Well, that's right. In fact, it's a role that we cherish. We have the opportunity to bring together such amazing leaders from throughout the entire state — small and rural, large and urban, all the systems and hospitals that compete in the marketplace on a day-to-day basis. But when they convene around the MHA table, we're convening for all the right things, trying to pull in the same direction. Certainly on public policy issues, but also shared learning and how we can improve on behalf of our patients and communities. And so that role, that convener role, is just incredibly important, and we cherish it.

Richard Helppie
That's got to be more difficult today with the consolidation, the systems kind of encroaching on each other's territory, and maybe natural competitive instincts. How are you doing as far as extracting that common element, that thing they can all chase together?

Brian Peters
Well, it's a great question, and from an association perspective, the word I use often is relevance. In other words, when I started at the MHA 36 years ago — if you can believe that — we had over 200 hospitals in the state. Virtually all of them were truly independent. And to your point, Rich, there's been so much integration and consolidation. We have so many large systems in the state now, and the question becomes: can we continue to provide services to them and provide value that establishes our relevance? What was relevant 36 years ago, in some respects, is still relevant today. But as we see these changes in the environment, we have to be nimble, and we have to be innovative. I think we have been at the MHA over time — we are a very different organization today than we were several decades ago. And I'm very pleased to say we are one of only a handful of state hospital associations in the entire country that has 100% membership. Every hospital, every health system, is a member in good standing of our association. So, Rich, when we walk into a lawmaker's office or when we engage with the media, we speak on behalf of the entire field, and that's something many other associations can't say.

Richard Helppie
And your role, because of your stature in the industry, has gone beyond the state of Michigan to national policy with the American Hospital Association. When you interact with the members here at the MHA in Michigan, and then go to Washington and deal with the broader platform, what are some of the similarities in policy objectives between Michigan and the national level, and what are maybe some of the differences?

Brian Peters
Well, it's a similarity and a difference all at once, and that's Medicaid. The similarity is that every single one of our colleague state hospital associations comes to D.C. and engages with their congressional delegation on the importance of continuing fair and adequate funding for the Medicaid program, because we've seen the growth in Medicaid over time, and we know it's a very significant portion of the patient population we're serving. So we come to that issue having the same end goal, the same objective — but where we differ is in the reality. There are 50 different state Medicaid programs in America, and that really came to light last year during the negotiations over H.R. 1, the "one big bill." In fact, Medicaid provider tax programs, Medicaid expansion — all of these different elements differ state to state, even here in the Midwest region, where there are some stark differences. So we have to ensure — at the AHA level, and I'm very honored to serve on the AHA board currently — that at the end of the day, Congress and the White House are hearing a consistent message. And that consistent message is: look, we may have unique qualities state to state, but Medicaid is a program that should not be marginalized. It's one that should be prioritized by our leadership.

Richard Helppie
Well, indeed — the "one big, beautiful bill," as it's been captioned, made it harder to stay on Medicaid. I know it's the fruit of political compromise, which is always inelegant at best, but to take a person who's trying to patch together a life, who's eligible for Medicaid, and yet make them apply twice a year, seems a little insane to me. I know you'll have cases in your member hospitals where someone is Medicaid-eligible, but the registration process is too much, so they don't follow through. That's another burden on your members.

Brian Peters
That's exactly our fear, Rich. As I've often said, we need to follow the lead of Amazon, for example, where the platform is so user-friendly — it's incredibly easy to purchase an item and have that process happen in a very efficient, effective way. That's what we need in terms of Medicaid eligibility verification. Because you're exactly right — we're concerned there are so many people here in Michigan who will qualify under an engagement or work requirement, but they won't be able to navigate that key step, and the technology will fail them. That's our concern. So we're working with our partners and the state, hopefully making sure that doesn't happen in Michigan. But we're not unique — that's a challenge all of our colleagues around the country are dealing with as well.

Richard Helppie
Indeed. And you know, Brian, employer-sponsored health care has been around for decades, thanks to a pivotal law passed in the 1940s that made the provision of a health plan by an employer not subject to reporting on the W-2. Are we nearing the end of the era of employer-sponsored health care?

Brian Peters
Well, it's a fair question to ask. Right now, affordability is the key conversation we're having in Michigan and, frankly, across the country. It's a topic at the American Hospital Association board table as well, and rightly so. Health care costs have exploded since the COVID pandemic — there's no question about it. There's a lot of finger-pointing going on these days. Some point at hospitals as the root cause; we can point at pharmaceutical manufacturers, everyone in the supply chain, or insurance companies. The fact of the matter is, we're not going to get out of this challenge by pointing fingers. We didn't get into this conundrum of high health care costs in a silo, and we're not going to get out of it by working in a silo. So we've really been calling on all the parties to come together — that convener role you mentioned earlier, Rich — and really talk about what can be changed about our financing and delivery system. And frankly, I'm a believer in technology. I think technology and artificial intelligence, as concerning as that may be for some, are going to have some incredible positive implications for the delivery of health care in this country.

Richard Helppie
Indeed. And sort of yoking health insurance to employment, in an age when we don't even know what enterprises are going to look like — where people are going to be more portable about where they work — seems to be something that's in its last legs. But people are still going to fight to keep it if that's their business. At the same time, Medicaid expansion and Medicaid availability do provide a great safety net and a little bit of financing toward providers, although many providers are delivering services at a cost greater than what they're reimbursed by Medicaid.

Brian Peters
You know, this question about the lifespan of employer-sponsored health coverage is just a fascinating and pertinent one, because employers are really fed up with the high cost of health care and what that means for their bottom line — and we get it. Whether that's a small business or a large corporation, the reality is we have an aging population that is demanding more health care. It's demanding more complex and costly health care. We have to understand those are the basic demographics we're dealing with in this country. So we can have the conversation about how we change the financing model and the delivery model, but that's the core reality we're dealing with in the United States. Now, having said that, I really believe politics is the art of the possible. So when I go to D.C., you'll hear from those on one side of the political spectrum who say, "You know what? It's time to abandon the employer-sponsored model altogether and have a government-paid approach, like some other countries have done — a one-payer, single-payer model." And then at the other end of the political spectrum, there are those who say we should eliminate Medicare and Medicaid altogether, get the government out of the financing of health care, and have a free-market approach. Now, I say politics is the art of the possible because the answer is somewhere in between. I don't think in this country we'll go to either one of those extremes, and quite frankly, I think it's not a productive use of time to talk about those two extremes, because they're not politically viable anytime in the near future. So let's come together and figure out what could be viable for this country.

Richard Helppie
Brian, any closing comments for your membership, the fine organization you lead, and the audience of the Common Bridge?

Brian Peters
Well, we always appreciate having the opportunity to chat with you, Rich. You're the best in the business and understand the state of play in health care today and into the future. I really want to emphasize that when you, your loved ones, your family members, and friends come to Michigan hospitals, please treat our caregivers with the respect they deserve. Unfortunately, we are seeing a real rise in instances of violence in the health care workplace. It's an important issue for a number of reasons, including the fact that we're trying our very best to recruit and retain talent at the bedside. It's a challenge, and having an unsafe or intimidating work environment, caused by people acting inappropriately, doesn't help our cause. So we really need to call on Michiganders to show some grace, show some respect. These people in our hospitals come to work every single day trying to do right by you and your family members, your loved ones. We're trying to provide the best quality care — please don't take out whatever frustrations you may have on these incredible people.

Richard Helppie
That's a great message — care for the caregivers. We've been talking with the chief executive officer of the Michigan Health and Hospital Association, Brian Peters, and on behalf of the association and the Common Bridge, this is your host, Rich Helppie, signing off.

The only judgment calls I made beyond spelling/grammar: I reunited two sentences that had clearly been split across the wrong speaker turn ("...we cherish" / "it. That's..."), fixed a garbled repeated phrase about the 1940s W-2 law, and lightly smoothed a couple of run-on or dangling sentences (e.g., the "your your family members" line and the "politics. The art of the possible" fragment) so they read grammatically while keeping the exact same points being made.