Health insurance in Michigan
- Michigan has a state-federal partnership exchange.
- Open enrollment for 2020 health plans will run from November 1, 2019 to December 15, 2019.
- Michigan had nine insurers offering plans on its exchange for 2019, plus two insurers that offer plans only off-exchange; all will continue to offer plans in 2020.
- 274,000 Michiganders enrolled in 2019 plans during the last open enrollment period.
- Short-term health plans are available in Michigan with initial plan terms up to 185 days.
- Michigan’s legislature has a GOP majority, but their margin shrank in 2018 election and voters elected a Democratic governor
- Michigan expanded Medicaid, and has received federal approval to add a work requirement after the end of 2019 (but whether or not the work requirement will be implemented is still uncertain).
- New Governor Gretchen Whitmer opposes the work requirement, but it’s unclear how much she can intervene in the process
- Medicare covers more than 2 million people in Michigan
Michigan exchange overview
Michigan has a state-federal partnership exchange. Nine insurers are offering plans in Michigan’s exchange for 2019, and all of them plan to continue to offer coverage in 2020. In addition, there are two insurers that offer individual market coverage in Michigan only outside the exchange.
After increasing individual market premiums by an average of just 1.7 percent for 2019, Michigan’s insurers have proposed an average premium decrease of about 2.5 percent for 2020.
In 2019, a 40-year-old in Lansing who earns $25,000/year can get a bronze plan in Michigan’s exchange for under $15/month after the premium subsidy is applied. Premium subsidies are available for people with income up to 400 percent of the poverty level. For 2019 coverage, that amounts to $48,560 for a single individual and $100,400 for a family of four, but the limits will be higher for 2020 (because the poverty level increases each year), at $49,960 for a single individual and $103,000 for a family of four.
In addition to the insurers offering plans in the exchange, two off-exchange-only insurers — Alliance Health and Life, and Health Alliance Plan — are offering plans for 2019, with average rates unchanged from 2018. And both have proposed keeping their rates unchanged again for 2020. Premium subsidies are not available for off-exchange plans, so they’re generally only a good option for people who know they won’t be eligible for a subsidy.
In 2019, enrollment in Michigan’s exchange reached 274,058, which was more than 20 percent lower than it had been in 2016, when enrollment peaked in Michigan’s exchange. Enrollment peaked in 2016 in the majority of the states that use HealthCare.gov, and has declined since then for a variety of reasons: The Trump administration’s decision to reduce funding for exchange marketing and enrollment assistance, the elimination of the individual mandate penalty, the expansion of short-term plans, and the higher premiums that unsubsidized enrollees had to contend with in 2017 and 2018.
Read more about the Michigan health marketplace.
Michigan and the Affordable Care Act
Michigan was considered a red state following the 2014 elections, and support for the Affordable Care Act has been mixed. But the tide has been turning more recently. Following the 2018 election, Michigan’s state legislature is still GOP-dominated, but the margins are much smaller than they were. And Democrats were elected to serve as governor, secretary of state, and attorney general.
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 the House 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 clinched a 9-5 majority following the 2014 elections, but the House representation from Michigan will be 7-7 following the 2018 election, with Democrats picking up two seats.
At the state level, Republicans control both the House and Senate, although their margins are smaller following the 2018 election. The legislature did not authorize a state-run health insurance exchange, despite former 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. And the state has received federal approval for a Medicaid work requirement, after enacting legislation to authorize the work requirement during the 2018 session. Governor Gretchen Whitmer is opposed to Medicaid work requirements, but it’s unclear how much latitude she’ll have to intervene in the process, which can be implemented anytime after the end of 2019.
Medicaid expansion and a pending work requirement
Former Governor Rick Snyder, a Republican, pushed for an alternative approach to Medicaid expansion in Michigan and ultimately gained bi-partisan support for Healthy Michigan. Medicaid expansion in Michigan uses the ACA’s eligibility guidelines (ie, up to 138 percent of the poverty level), but the state obtained approval from the Obama Administration to charge premiums when enrollees’ incomes are above the poverty level.
Medicaid expansion took effect under the ACA on January 1, 2014, but Michigan was a few months behind due to the state’s waiver process. Enrollment began April 1, 2014, and 632,254 people were enrolled in Healthy Michigan as of August 2019 (that was down from June 2018’s enrollment of 676,250).
The state is seeking to reduce Healthy Michigan’s enrollment, however, with a work requirement slated to take effect in 2020. Michigan enacted legislation in 2018 directing the state to seek federal approval for a work requirement.The waiver proposal was submitted to CMS in September 2018, and was granted federal approval in late 2018.
It was still pending CMS approval when Gretchen Whitmer, a Democrat opposed to Medicaid work requirements, won the gubernatorial election in Michigan. Snyder was term-limited and did not run for re-election in 2018. Whitmer was Michigan’s Senate Minority Leader in 2013 when Healthy Michigan passed and was instrumental in ensuring that the state would expand Medicaid.
It’s unclear whether Whitmer will be able to intervene in the Medicaid work requirement waiver process, given that all of the details are in statute. And work requirements in Kentucky, Arkansas, and New Hampshire have been struck down by a federal judge in 2019. It’s possible that decision could be overturned during the appeals process, but for the time being, Medicaid work requirements are in legal limbo.
As of April 2019, 2.3 million Michigans were enrolled in Medicaid/CHIP – a 21 percent increase over the enrollment total at the end of 2013.
Read more about Medicaid expansion in Michigan.
Short-term health insurance in Michigan
Michigan regulations limit short-term health insurance plans to no more than 185 days in duration and prohibit renewal. An applicant can purchase additional short-term plans, but cannot have more than 185 days of short-term coverage from one insurer in any 365-day period.
Read more about short-term health insurance in Michigan.
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 in the fall of 2015, Consumers Mutual announced its closure and ceased operations at the end of 2015. As of mid-2019, there were only four CO-OPs remaining, offering plans in five states (Maine, Montana, Idaho, New Mexico, and Wisconsin).
Medicare in Michigan includes state protections for consumers
Michigan Medicare enrollment exceeded 2 million people as of early 2018, and has continued to grow, as is the case nationwide. As of mid-2019, there are about 2.06 million Michigan residents with Medicare coverage.
Based on 2016 data, 82 percent of Michigan Medicare recipients were eligible based on age alone, while the other 18 percent were on Medicare as the result of a disability.
Michigan has a Medigap subsidy program to help offset the cost of Medigap coverage for enrollees with modest income. And the state also protects access to certain Medigap plans for people who are disabled and enrolling in Medicare under the age of 65.
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 and don’t mind the limited provider networks and potentially higher out-of-pocket costs (versus Original Medicare plus a Medigap plan and Part D plan; out-of-pocket costs are actually unlimited with Original Medicare alone). Forty percent did so as of September 2018; nationally, 36 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: