Two major studies show that overall health scores are declining in Michigan. Obamacare – also known as the Affordable Care Act – is intended to give more Americans access to quality health care by making insurance coverage better and more affordable. Use this summary to see if Michigan is taking advantage of the ACA to help improve its citizens’ health.
Michigan health ratings
Michigan’s overall health ranking dropped dramatically from 15th in 2009 to 26th in 2014 according to The Commonwealth Fund’s Scorecard on State Health System Performance. The Michigan Scorecard details the health measures that are evaluated to establish the overall score.
America’s Health Rankings, which are published by the United Health Fund, ranked Michigan 34th in 2013, the most recent edition available. Michigan was 33rd in 2012. Michigan ranks well for its low uninsured rate and small disparity in health status based on the level of education completed. Health challenges in Michigan include high rates of smoking and binge drinking, a high obesity rate, and a high violent crime rate.
The 2014 edition of Trust for America’s Health is another good source of public health information; see Key Health Data About Michigan.
Are you interested in the health scores for a specific county? See county-by-county health rankings for Michigan from the Robert Wood Johnson Foundation and the Population Health Institute at the University of Wisconsin.
Michigan and the Affordable Care Act
Michigan can be considered a red state following the 2014 elections, and support for the Affordable Care Act is mixed.
Sen. Carl Levin and Sen. Debbie Ann Stabenow, both Democrats, voted in favor of the Affordable Care Act in 2010. Levin will retire in January 2015 and be replaced by U.S. Rep. Gary Peters, a Democrat. Peters voted for the ACA in 2010.
Michigan’s delegation to the U.S. House of Representatives split along party lines in the 2010 ACA vote. Eight Democrats voted yes, while seven Republicans voted no. Michigan lost a House seat following the 2010 census. Republicans hold a 9-5 majority following the 2014 elections.
At the state level, Republicans control both the House and Senate. The legislature did not authorize a state-run health insurance exchange, despite Gov. Rick Snyder’s preference for that approach. Michigan was among the handful of states that implemented a partnership exchange.
Michigan did expand its Medicaid program through the ACA, but included some unique provisions that required federal approval.
How did the ACA help Michigan?
Michigan experienced a small drop in the percentage of people who do not have health insurance since the ACA’s individual mandate went into effect. In 2013, the uninsured rate was 12.5 percent; as of mid-2014, it stood at 11.9 percent. Nationally, the uninsured rate as of mid-2014 was 13.4 percent.
Michigan enrollment in QHPs
More than 272,500 Michigan residents, or 3.76 percent of potential enrollees, selected a qualified health plan (QHP) during 2014 open enrollment. Nationally, the average was 28.0 percent.
Of those Michiganders signing up for a QHP, 87 percent qualified for premium tax subsidies to make their plans more affordable. Those subsidies reduced the average monthly premium to $97. Thirty-nine percent of Michigan residents receiving subsidies had their monthly premium reduced to $50 or less.
For 2015, the health insurance marketplace features more options and a slight decline in premiums. In total, 16 insurers are selling policies through the Michigan exchange, four more than in 2014 according to HHS. On average, marketplace premiums are 1 percent lower than in 2014, according to the Commonwealth Fund.
Michigan takes unique approach to Medicaid expansion
As in other states, Michigan will expand Medicaid coverage to all residents with incomes up to 138 percent of the federal poverty level. However, Michigan received a federal waiver for its Healthy Michigan plans, which applies to those earning between 100 percent and 138 percent of FPL. People in this category will be required to pay premiums equal to two percent of their household income.
Also unique to Michigan, all beneficiaries contribute to a “MI health account” to pay their copayments. Copayments are reduced for healthy behaviors. Total cost sharing is capped at five percent of family income.
Enrollment in Healthy Michigan has exceeded all projections. Officials expected about 320,000 people to sign up in the first year and enrollment to top out at 470,000. However, nine months after enrollment opened (April 2014), signups reached 496,870.
Gov. Snyder is hopeful that Healthy Michigan will both improve the quality of life for Michigan and contribute to the long-term economic health of the state. Officials are encouraged that individuals enrolled in the program are using their new coverage to seek care proactively. The director of the Michigan Department of Community Health touted that enrollees in the program made 315,000 primary and preventive care visits in the first eight months, including 241,000 primary care visits, 74,000 preventive care visits, 22,900 mammograms and 10,900 colonoscopies.
Other ACA reform provisions
The ACA’s Consumer Operated and Oriented Plan (CO-OP) Program encourages the formation of a new type of medical insurance company. CO-OPs are non-profit, consumer-run plans, and they are intended to increase choice and competition.
In 2014, CO-OPs operated in 23 states. Three of the CO-OPs are expanding into neighboring states in 2015.
Michigan Consumer’s Mutual CO-OP was founded with a $71.5 million dollar loan. Consumer’s Mutual hoped to enroll 37,000 members during the initial open enrollment period. In February 2014, a company executive told The New York Times that the CO-OP was lagging behind its goals, but didn’t share enrollment numbers.