Nearly $3 million in dark-money nonprofit spending backed the measures
Voters in Benton Harbor, Lansing, East Lansing, Kalamazoo and Portage approved charter amendments in the Nov. 3 election creating “citizens’ advisory health action” committees charged with recommending ways to lower healthcare costs and improve healthcare policy. The measures passed by wide margins: 80% approval in Benton Harbor, 69% in East Lansing, 69% in Kalamazoo, 66% in Lansing and 55% in Portage.
The amendments require each city to seat a seven- or eight-member committee that must hold public forums to hear firsthand accounts of how healthcare costs affect community members, examine the role of federal and state policy in setting costs, track federal and state officials’ votes on healthcare legislation, and prepare a “Healthcare Action Plan” for city leaders by Oct. 1 of each even-numbered year. City councils must then hold public hearings on the plan by Oct. 15 of the same year. Members will not be paid for their work, though they can be compensated for costs under the ballot language, and the new rules require them to have the necessary “research, analytical and community engagement skills.” It now falls to each city government to establish its committee — an assignment carrying uncertain costs and outcomes.
The measures passed with healthcare costs top of mind for many voters. A late-October poll of Michigan voters showed high costs were a top concern, with health insurance or medical costs the primary driver. “Voters sent a clear message,” said Ryan Cohn, a spokesperson for City Action Michigan, the nonprofit driving the effort, who works for the Florida-based public relations firm Sachs Media. “They want action on healthcare costs, and they’re done waiting for Congress to deliver it.”
The initiatives also intertwined policy with electoral politics. The amendments appeared on ballots only in largely Democratic cities within two toss-up congressional districts, and campaign advertising prominently attacked the Republican incumbents — U.S. Reps. Tom Barrett and Bill Huizenga, both unseated in close races on Nov. 3. 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, support for the proposals in the five liberal-leaning cities generally lagged behind support for major Democratic candidates such as Gov.-elect Jocelyn Benson.
City Action Michigan’s ballot committee reported receiving $2.8 million in donations through mid-October, exclusively from dark-money nonprofits outside Michigan that are not required to disclose their donors. They include American Opportunity Action, Cityscope, Global Impact Social Welfare Fund and Global Impact Ventures — groups that have been known to channel funding to liberal political initiatives while masking donor identities. Liberal “dark money” groups spent nearly $3 million on the initiatives in all, much of it on advertising supporting the proposals and on canvassers who collected signatures to put the measures on local ballots.
City Action Michigan also disclosed giving $100,000 to Berrien Forward, the 501(c)(4) nonprofit of Chokwe Pitchford, a Berrien County commissioner whose organization was paid by City Action Michigan to build support for the proposals. Pitchford said the money, reported as a grant, paid 17 canvassers who promoted the measures 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,” Pitchford said.
Pitchford acknowledged it is a “fair criticism” to note that neither he nor the voters know where the money came from. 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. He dismissed concerns that the initiative could set a precedent in which 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.
Texas Charter Township trustee Barb Hammond, the only representative of City Action Michigan — formerly Community Action Michigan — whom the campaign had not reported paying as of mid-October, declined repeated interview requests from Bridge Michigan.
Some local officials have called the effort misguided. In October, the Kalamazoo City Commission passed a resolution unanimously opposing the ballot measure. Mayor David Anderson said in public meetings that he worried organizing and running the committees would impose a lasting financial burden 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.” Commissioner Chris Praedel criticized the dark money behind the campaign, warning 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.”
How much the committees will cost the cities going forward remains unclear. “I would not envision it would be a lot,” said Alex Little, city manager in Benton Harbor. Lansing Mayor Andy Schor, speaking to Bridge Michigan before the election, expressed ambivalence and acknowledged the proposals made a political point. “If the voters want it, then we’ll set up a committee and we’ll do it,” Schor said. Spokespersons for East Lansing and Portage said city officials will now review next steps.
Whatever the committees produce, their leverage is limited. Municipal advisory boards and committees tend to focus on specific city operations such as parks, libraries or transit systems, Little said; the new panels are different: “this is more of a study group to understand price and services for healthcare,” he said. Decisions in a national healthcare system of “infinite complexity” are mostly guided by federal and state policy, said Scott Greer, a University of Michigan professor who researches how political systems shape health policy decisions. Medicaid eligibility changes, meanwhile, are expected to reduce coverage and cost providers millions of dollars.
Still, Greer said the biennial reports will force “hyper-local” conversations that otherwise might not happen. A community might document how much emergency care goes to homeless residents, then shift policy toward extending more routine care as a way to keep chronic conditions in check, he suggested — a potential cost saving as those patients rely less on expensive emergency room care. Cohn said the committees can advise officials whose policies could support local health providers in ways that drive down costs, and can offer collective voices that can reach Lansing. Pitchford 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?”
Benton Harbor shows both the pull and the constraints. The city’s hospital closed 40 years ago, and its median income of just above $31,000 is among the lowest in the state, Little said. He said Benton Harbor may not have enough residents with healthcare and financing backgrounds to serve on its board, and the city’s public health initiatives are run through the county health department. The city is also facing hundreds of thousands of dollars in extra costs for ambulance services because so many local patients are uninsured, Little said. Perhaps an advisory committee focused on healthcare can find a solution, he said.