When it comes to health and healthcare reform, Michigan tends to fall somewhere in the middle. The state’s health rankings have dropped a bit in recent years, and the state has partially embraced Obamcare. Still, the Great Lakes State has an uninsured rate lower than the national average and seems to be making improvements on certain health measures.
This brief guide highlights public health in Michigan as well as the state’s implementation of the Affordable Care Act, including its Medicaid expansion waiver.
Michigan health ratings
Michigan’s overall health ranking dropped dramatically from 15th in 2009 to 31st in 2015 according to The Commonwealth Fund’s Scorecard on State Health System Performance. The state ranked among the top 10, coming in at #6, for its low percentage of uninsured children (4 percent) – it placed #13 for percentage of uninsured adults (12 percent). Data for this indicator came from 2014. See Michigan’s scorecard for further details on the health measures that are evaluated to establish the overall score.
Michigan placed 35th in United Health Foundation’s America’s Health Rankings, 2015. This ranking also cited Michigan’s low percentage of uninsured among its major health strengths and ranked it 13th for this measure. The Great Lakes State ranks near the bottom for preventable hospitalizations, public health funding, and childhood immunization.
The 2015 edition of Trust for America’s Health is another good source of public health information; see Key Health Data About Michigan.
If you are 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. Statewide, Michigan’s uninsured rate ranged from 9 to 20 percent and was, on average, 2 percentage points higher than the top U.S. performers (11 percent).
MI health insurance carriers, rates 2017
Michigan will continue to oversee its exchange while enrolling individuals, families and small groups through the HealthCare.gov platform.
With the departure of UnitedHealthcare from the individual market at the end of 2016, Humana offering only HMO plans through the exchange, and other changes, Michigan enrollees can expect their 2017 open enrollment options to look a bit different.
Michigan carriers that have filed rate change proposals for 2017 include:
- Alliance Health and Life Insurance Company
- Blue Care Network
- Blue Cross Blue Shield of Michigan
- Harbor Health Plan
- Health Alliance Plan
- McLaren Health Plan
- Physicians Health Plan
- Priority Health (HMO)
- Total Health Care USA
Rates will be finalized by November 1, 2016, when the 2017 open enrollment period begins. Charles Gaba at ACA Signups has calculated an average rate increase of 16.59 percent for Michigan’s individual market, including some off-exchange plans.
Michigan enrollment in qualified health plans
During the 2014 open enrollment period, more than 272,500 people, or 3.76 percent of potential enrollees, selected qualified health plans (QHPs) through Michigan’s health insurance exchange (i.e., Healthcare.gov). 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.
Michigan’s enrollment improved greatly in 2015 and 2016. At the end of 2016 open enrollment, 345,813 people had purchased private health insurance plans through the exchange. Of these enrollees, 33 percent were new and 84 percent received financial assistance in the form of subsidies.
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.
Sens. Carl Levin and Debbie Ann Stabenow, both Democrats, voted in favor of the Affordable Care Act in 2010. Levin retired in January 2015 and was 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 it included some unique provisions that required federal approval.
Michigan’s unique approach to Medicaid expansion
Michigan chose to 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 2 percent of their household income.
Also unique to Michigan Medicaid, all beneficiaries contribute to a “MI health account” to pay their copayments. Copayments are reduced for healthy behaviors. Total cost-sharing is capped at 5 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.
While Healthy Michigan was initially approved, the state was required to submit a second waiver requesting higher cost-sharing or a transition to subsidized coverage through the exchange after 48 months in the program. The waiver was submitted to CMS on September 1, 2015, and approved mid-December 2015. Had it not been approved, the Healthy Michigan program would have ended April 30, 2016, and the state’s Medicaid expansion would not continue.
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.
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.
Within days of 2016 open enrollment beginning, Consumers Mutual announced its closure and ceased operations at the end of 2015. As of August 2016, there were only 7 CO-OPs remaining.
Medicare enrollment in Michigan
Based on 2013 data, 81 percent of Michigan Medicare recipients were eligible based on age alone, while the other 21 percent were on Medicare as the result of a disability.
Michigan Medicare costs exceed the national average ($8,970), with the program spending about $9,555 per enrollee annually. As of 2009, the state ranks 8th overall in annual spending with $17.6 billion per year.
In Michigan, Medicare beneficiaries can enroll in Medicare Advantage plans instead of original Medicare if they wish to gain additional benefits beyond what traditional coverage offers. 32 percent did so in 2015; nationally, 31 percent of all Medicare recipients nationwide choose Medicare Advantage.
State-based health reform legislation
Here’s a summary of recent Michigan bills related to healthcare reform: