Protect healthcare for 650,000 Michiganians

pdficonApril 2017
Emily Schwarzkopf, Policy Analyst

Continuation of the Affordable Care Act (ACA) and the Healthy Michigan Plan are critical for Michigan residents and the state’s economy. In recognition of the program’s success, the governor recommended, and the League supports, sufficient funding for the Healthy Michigan Plan in the 2018 budget year.

Budget Brief JPG USE THIS ONE

Sixty percent of Healthy Michigan enrollees report that their ability to access primary care was better than prior to being enrolled, and 70% stated that they were more likely to contact a primary care provider before going to the emergency room. Eighty-six percent of enrollees have reported that their ability to pay their medical bills has improved since being enrolled in the program.

The program has also made a significant impact on Michigan’s economy. The Healthy Michigan Plan has resulted in 30,000 jobs annually, $2.3 billion in additional personal spending power, and $150 million in state tax revenue as a result of added economic activity. Further, 90% of hospitals report reductions in uncompensated care, with overall uncompensated care dropping by nearly 50% across the state.

BACKGROUND ON MEDICAID EXPANSION

When it was first passed, the ACA included a requirement that states expand Medicaid to those with family incomes at or below 133% of the federal poverty level. The existing Medicaid program generally had only covered the aged, blind and disabled up to 100% of poverty, with higher income levels for certain populations (children and pregnant women) and lower for others (childless adults).

However, the June 2012 United States Supreme Court decision questioning the constitutionality of the ACA (National Federation of Independent Business v. Sebelius) found the provision to require states to expand Medicaid unconstitutional. As a result, states were given the option to expand their Medicaid programs without penalty. State programs would be covered 100% by federal funding through calendar year 2016. The federal match rate will phase down to 90% over the next five calendar years: to 95% in 2017, 94% in 2018, 93% in 2019 and 90% in 2020 and all subsequent years.

BB Protect healtcare for 650,000 Michiganians chart 1The Healthy Michigan program has been shown to be incredibly successful for those receiving coverage through the plan. The benefits for Healthy Michigan enrollees must be based on federal benchmark coverage and include the 10 essential healthcare services. The plan also covers dental and vision services, hearing aids and nonemergency medical transportation.

MICHIGAN’S FEDERAL WAIVERS

The legislation that created the Healthy Michigan program required Michigan to get two waivers from the federal government. The first waiver allowed the state to include cost-sharing requirements (including copays) and the use of health savings accounts into which newly-eligible enrollees would contribute. The contributions of enrollees could be reduced if certain healthy behaviors are addressed.

The second waiver limited the amount of time an enrollee could be enrolled in the Healthy Michigan Plan to 48 months. Once the 48-month cap is reached, an individual would have the opportunity to remain on Medicaid with higher cost-sharing requirements or purchase private insurance through the healthcare exchange and be considered eligible for premium tax credits. Both of these waivers were approved by the federal government.

Another important component of Michigan’s legislation is that should annual state savings and other nonfederal savings associated with the implementation of the program not be sufficient to cover the reduced federal match, the Healthy Michigan program would end. The state realizes savings from programs that were previously funded either partially or entirely by the state General Fund that are now covered in Healthy Michigan, including non-Medicaid mental health funding, Adult Benefits Waiver program, prisoner healthcare costs and Plan First! Waiver program costs. Savings can also be seen as a result of revenue from the Health Insurance Claims Assessment, the use tax on Medicaid managed care organizations, provider assessments and an established hospital quality assurance assessment program retainer on special hospital payments.

CONTINUED THREATS

Despite the recent defeat of the federal American Health Care Act, there is still the possibility that Congress will fundamentally change the way Medicaid funding is allocated and limit how long Medicaid expansion will continue. As Congress moves forward on other priorities, including tax reform, there is the possibility that Congress, in order pay for tax breaks, could shift the costs of the Medicaid program to the states through block grants or per capita caps. There also is a chance that Congress could make changes in Medicaid financing in the forthcoming federal budget or when the Children’s Health Insurance Plan (CHIP) funding is reauthorized in late summer or early fall. While the League encourages the Michigan Legislature to continue funding for the Healthy Michigan Plan in 2018 and beyond, it is also important to stay vigilant in protecting Medicaid funding and the Affordable Care Act.

THE GOVERNOR’S 2018 BUDGET RECOMMENDATION

The governor’s executive budget proposal includes continued funding for this critical program. Since the state is required to pay a share of the costs, the governor has recommended total funding of $4.1 billion, including a $200.4 million investment of state General Funds to cover the costs of the state’s match contribution. This amount does not take into account additional savings from revenue impacts or other budgetary savings created as result of the implementation of the Healthy Michigan Plan.

With federal budget cuts, the sky may really be falling

My son loves books, and one of our favorite things to do every night is read before bed. Many of the stories we choose also provide a learning experience. One of our recent favorites has been Chicken Little, which I think my son chooses to laugh at me stumbling over tongue-twisting character names. It also gives us a chance to talk about thinking rationally.

This lesson is applicable from our kids to my policy work to the highest levels of government. But when President Donald Trump released his “skinny budget” in March—despite being light on detail—the potential impact it could have on our state budget and Michigan residents was stifling. And at times, I really do feel like the sky is falling.

My fear is not unfounded. Michigan has grown increasingly reliant on federal funds. Over the past decade, while our total state budget has grown by about 29%, federal funds in our budget have grown by nearly 69%. In our current budget, federal funds provide $22.7 billion of our $54.2 billion state budget. This means that more than $4 out of every $10 provided for important programs like public education, healthcare for children and families with low wages, food assistance and road maintenance are paid for by federal dollars.

Think-the-federal-budget-does-not-matter_CROP

These federal grants do matter to our state budget. According to a recent report from the Center on Budget and Policy Priorities, federal grants to states and local governments make up nearly one-third of non-defense discretionary spending. Michigan receives 3% of total federal grants to states, and only California, New York, Texas, Florida, Georgia, Illinois, Pennsylvania and Ohio get a bigger share than Michigan. Cuts to these discretionary programs, which are already at historically low levels, would harm workers, college students, local communities and families with low- and moderate-incomes.

What’s more is that this “skinny budget” proposes to completely eliminate funding for the Low Income Home Energy Assistance Program (LIHEAP), which helps families and many seniors pay heating bills; a block grant that supports housing, community facilities and economic development; the HOME program which helps develop and repair affordable rental housing and repair homes for homeowners with low incomes; and the Community Services Block Grant, which provides anti-poverty services.

While President Trump’s budget only outlines changes in discretionary spending, changes to mandatory grants may still be forthcoming, for example block granting or putting a per capita cap on Medicaid. (While the first round of the American Health Care Act was withdrawn, you can bet that Congress will try, and try again, to repeal the Affordable Care Act and alter Medicaid funding.) Changes in these programs, including Medicaid, the Children’s Health Insurance Program (CHIP), free and reduced-priced school meals, child care assistance and other assistance for families with low incomes, would mean deep cuts to these programs as states would be unable to absorb the costs themselves. This would reduce services to those Michigan residents who really need it.

Cuts to federal grants to state and local governments, and changes in federal programs, will only mean cuts to the very Michigan residents that rely on these services. Changes will result in more potholes and unsafe bridges, fewer Michigan residents with healthcare coverage, more children going hungry, less affordable housing, more poverty and more problems, all having a long-term negative impact on our economy.

So pardon my doomsday sentiment, but states really rely on federal funds to run. And these changes would affect our state for years to come. But we can change the future. It is important for all of us to get in touch with our members of Congress and tell them the things that really matter to us as they make decisions on the federal budget that will have a direct impact on our great state.

— Rachel Richards

Affordable Care Act – Reasons to be grateful

choose to be gratefulRecent employment numbers and unemployment rates should dispel the “job killer” label and negative predictions of those who oppose the Affordable Care Act (ACA). The national unemployment rate in March 2010, the month the ACA was signed into law, was 9.9%. The unemployment rate in October 2015 was 5.0%, nearly a 50% reduction. In addition, significant employment gains—jobs—have been made over this same period. (more…)

Good news: The ACA is working as intended

It has been said many times before, but bears repeating—the Affordable Care Act (ACA) is doing what it was designed to do. The ACA has succeeded in providing quality healthcare coverage and reducing the number of uninsured, and with its consumer protections, fewer individuals are experiencing trouble paying medical bills. According to a recent Gallup Poll, only Texas maintains an uninsured rate greater than 20% of its residents, no state has reported a statistically significant increase since 2013, and seven states through the first half of 2015 have uninsured rates that are at or below 5%. (more…)

Healthy Michigan plan surpasses all expectations by first anniversary

The Healthy Michigan Plan, Michigan’s Medicaid expansion program, celebrates its first anniversary today. What an amazing year it has been for the program – with enrollment currently just over 600,000! The governor’s budget for 2015 estimated enrollment at 400,000 and 450,000 for budget year 2016. The budget released in February 2015 revised those estimates upward to 540,000 for 2015 and 580,000 for 2016. Those forecasts already have been surpassed – and it’s only April. (more…)

Supreme Court: Another chance to affirm ACA as the law of the land — the whole land

There is a lot at stake for about 300,000 Michiganians as the U.S. Supreme Court begins consideration of the King v. Burwell case today.

This case will  determine whether the Affordable Care Act permits the federal government to provide premium tax credits to qualifying individuals anywhere in the U.S. or only in states that established their own Health Insurance Marketplaces.

An adverse ruling in this case could eliminate these tax credits established in the law to make coverage more affordable. It is hard to imagine that Congress would have intended to pick winners and losers for healthcare coverage in such an arbitrary and surreptitious manner. (more…)

400,000 reasons to give thanks

From the First Tuesday newsletter
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As we head into the month of November, there are more than 400,000 reasons to give thanks.

That’s how many previously uninsured or underinsured people in Michigan are now able to access healthcare thanks to the Healthy Michigan Plan.

The plan passed the Michigan Legislature last year with bipartisan support as part of Medicaid expansion under the Affordable Care Act. About half the states have taken this step to improve the health of their citizens.

The League was part of a strong, diverse coalition that supported the expansion. Those efforts are now bearing an amazing amount of fruit. (more…)

Healthy Michigan plan enrollment tops 275,000

Enrollment in the Healthy Michigan Plan as of June 2 totals 276,622. This is truly remarkable considering the program was implemented just over two months ago on April 1. Genesee County, at 98.5%, has enrolled the highest percentage of those potentially eligible. What a great achievement.

The Healthy Michigan Plan is Michigan’s unique Medicaid expansion plan. It provides comprehensive healthcare coverage to Michigan’s low-income uninsured residents. To be eligible for the program, an individual must be between the ages of 19 and 64, not currently eligible for Medicaid or Medicare, a citizen or lawfully admitted to the U.S., and have income less than 133% of the federal poverty level (up to $15,521 for an individual or $31,721 for a family of four).

Application for the program can be made by phone (1-855-789-5610), online at www.michigan.gov/mibridges, or in person at a local Department of Human Services office. Applications made through the on-line system can have eligibility determined in a matter of minutes and sometimes even seconds. (more…)

Healthy Michigan Plan gets healthy start!

The Healthy Michigan Plan, Michigan’s Medicaid expansion, opened for enrollment on April 1, and within the first 72 hours, 36,329 applications were submitted through the MIBridges website and 20,995 were approved for coverage. By Tuesday, the number of enrolled shot up to 59,280 — an amazing number for a two-week period.  That means that more than 109,000 people are now covered, including those who were transferred over to the plan from the Adult Benefits Waiver program.

The program is off to a great start — great news for Michigan’s low-income uninsured. The online enrollment system is working well with the majority of applications being processed in a matter of minutes or even seconds. (more…)

Attorney general needs to move on

Attorney General Bill Schuette continues his fight to harm Michiganians by pursuing frivolous lawsuits against the Affordable Care Act.

First he fought to have the law declared unconstitutional and lost — the U.S. Supreme Court ruled the ACA does not violate the Constitution. Now he is fighting to end the premium tax credits for more than 144,000 Michiganians who have so far qualified for them.

Nearly 87% of those who have enrolled in a health plan in Michigan are eligible for premium tax credits to help them pay their insurance premiums. Why would he want to harm more than 144,000 people in his state — his neighbors, his friends, his constituents? (more…)

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