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.
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 state ranked in the bottom five for two health indicators: Medicare 30-day hospital readmissions and total Medicare reimbursements per enrollee. The Michigan Scorecard further details the health measures that are evaluated to establish the overall score.
Michigan placed 34th in United Health Foundation’s America’s Health Rankings for the second year in a row. The 2014 edition, which is the most recent available, showed Michigan’s smoking and preventable hospitalization rates had each decreased by 8 percent in the past year. Michigan earned positive marks for low rates of uninsured individuals and infections disease and, as well as ready availability of dentists. Still, the state faces challenges when it comes to poor public health funding and high rates of obesity, cardiovascular deaths and binge drinking.
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.
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.
How has Obamacare helped 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 state’s uninsured rate was 12.5 percent, well below the 17.3 percent uninsured rate nationwide. By the end of 2014, it stood at 10.8 percent. Nationally, the uninsured rate in December 2014 was 13.8 percent.
Michigan’s uninsured rate continued to fall in 2015, reaching 8.5 percent by mid-year—significantly lower than other states that only expanded Medicaid, only created a state/partnership exchange, or neither. Among those states, the uninsured rate was 13.4 percent, and nationally it was 11.7 percent.
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.
2015 enrollment reached 341,000, and 42 percent of enrollees were new to the marketplace. As happens across the country, some people failed to make their initial premium payments or cancelled their coverage, and effectuated enrollment was 288,751 at the end of June. Of those remaining in their plans, nearly 78 percent were receiving advanced premium tax credits and 54 percent were receiving cost-sharing reductions.
For 2016, one less carrier will offer coverage to Michigan residents. Within days of 2016 open enrollment commencing, Consumers Mutual Insurance of Michigan, the state’s ACA-created CO-OP, announced that it would cease operations by the end of the year and current members would need to find new coverage for 2016.
Michigan’s individual health insurance market includes 14 carriers offering about 200 plans through the state’s federally facilitated exchange:
- Alliance Health and Life Insurance Company
- Blue Care Network
- Blue Cross Blue Shield of Michigan
- Harbor Health Plan
- Health Alliance Plan
- McLaren Health Plan Community
- Physicians Health Plan
- Priority Health
- Priority Health Insurance Company
- Total Health Care USA
- UnitedHealthcare Community Plan
Michigan consumers will also see a slight increase in rates. On August 18, the Michigan Department of Insurance and Financial Services announced a weighted average rate increase of 6.5 percent in the individual market. However, that number is lower with Consumer’s Mutual exiting the market; the CO-OP had the highest increase of all exchange carriers: 20.5 percent.
Michigan’s unique approach to Medicaid expansion
As in other states, 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, 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 a response is expected by December. If CMS rejects the waiver, Healthy Michigan will end April 30, 2016.
By the end of 2015 open enrollment, 82,135 people had enrolled in Healthy Michigan through the state’s federally facilitated exchange. From 2013 to August 2015, Michigan Medicaid enrollment has increased 21 percent, with total monthly enrollment reaching 2.3 million. Medicaid enrollment continues throughout the year.
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. Within days of 2016 open enrollment beginning, Consumers Mutual announced its closure and joined the ranks of 11 other CO-OPs that will cease operations by the end of 2015.
Medicare enrollment in Michigan
Michigan Medicare enrollment reached about 1.9 million – 19 percent of the state’s population. Nationwide, 17 percent of the population is enrolled in Medicare. Historically, 79 percent of Michigan Medicare recipients qualify based on age alone, while the other 21 percent are on Medicare as the result of a disability.
Medicare spends about $10,924 per Michigan enrollee each year, and 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. Nearly 33 percent of Michigan Medicare recipients are enrolled in Medicare Advantage plans; 32 percent of all Medicare recipients nationwide choose Medicare Advantage.
Almost 58 percent of Michigan Medicare recipients are enrolled in Medicare Part D plans, which provide stand-alone prescription drug coverage. Nationally, 43 percent are enrolled in stand-alone Rx plans.
State-based health reform legislation
Here’s a summary of recent Michigan bills related to healthcare reform: