Legislation, House Bill 4714, is being debated in the Michigan House of Representatives to expand Medicaid eligibility under the Affordable Care Act — but only if the federal government agrees to unreasonable demands.
While the bill is a step that opens a previously closed door to discussion, the contents of the bill differ greatly from that supported by Gov. Rick Snyder and raise many questions and serious concerns. It demands submission of an unreasonable federal waiver, and if all provisions are not approved, expansion does not occur.
While it would cover “nondisabled adults ages 21-64” with incomes up to 133% of the federal poverty level ($15,282 for an individual, $31,322 family of four), it also requires a contribution for healthcare costs of up to 5% of annual income as well as establishes a 48-month time limit. A 5% contribution requirement seems excessive for low-income working individuals and families, who are currently struggling to make ends meet.
Implementing a 48-month time limit for current and new (nondisabled) adult recipients seems very harmful to long-term health outcomes. Diabetes and high blood pressure cannot be cured in 48 months, for example.
With Michigan recently regaining its No. 1 national ranking in the number of people who have lost employer-sponsored coverage, 1.6 million, over the last decade, the time limit is even more troubling. The number of workers ages 18-64 with employer-sponsored coverage fell by 1.23 million, the largest drop in the nation over the last decade. Jobs with healthcare coverage are harder and harder to find.
What impact would time limits have on infant mortality? Michigan currently ranks 37th. What would happen to a pregnant woman who has exceeded her 48-month time limit? Right Start data demonstrates we have a long way to go to improve maternal and infant health without restrictions such as time limits.
What about the 50,000 direct care workers in nursing homes, assisted living facilities and those who provide home care who are expected to qualify for expanded Medicaid eligibility?
The legislation suggests individuals “may select private health insurance” through the Healthcare Market Place or privately once the 48 months end. However, those with incomes below 100% of the federal poverty level ($11,490 for an individual, $23,550 for family of four), are ineligible for federal subsidies to purchase coverage through the Healthcare Market Place, and no state subsidies are proposed. It is unlikely that community direct care workers with median annual earnings of $12,000 would be able to purchase coverage without subsidies.
There are many, many other examples of hardworking, low-wage individuals who do not have access to healthcare coverage – child care workers, retail sales, servers in restaurants, employees in small businesses, who would benefit from expanding Medicaid eligibility. They are not expecting a “handout.” They just need a little help.
Business understands it can’t solve healthcare issues alone. Several regional chambers of commerce as well as the Small Business Association of Michigan strongly support the governor’s proposal. They recognize the opportunity and importance of having a healthier workforce for the long run and ending the cost shifting that occurs when there are high numbers of uninsured.
Serious discussion is needed on this legislation to make it work for low-income, hardworking Michiganians. I am constantly reminded that we are all one catastrophic diagnosis away from healthcare insecurity and economic disaster. I concur with the lawmaker who said: “Medicaid is not a way of life.” Rather it is a way to have or to save a life.
— Jan Hudson