In The Media Archive

Reports show the way Americans receive and pay for health insurance has been changing for more than 10 years

The Center for Healthcare Research & Transformation (CHRT) today released two briefs showing that for more than a decade, employers have been dropping health insurance and consumers have been paying more out-of-pocket for health care, a trend that began many years before the development of the Affordable Care Act. The research briefs also show Michigan’s employers are increasing employee cost-sharing and moving to high deductible health plans at a faster rate than the national average.

According to the data, from 1999 to 2011, the proportion of individuals covered by employer-sponsored insurance decreased by approximately 15 percent nationwide. Between 2008 and 2011 specifically, the proportion of people with private health insurance (either through their employers or individually-purchased) fell 4.7 percent in Michigan and 4.4 percent nationwide.Continue Reading Reports show the way Americans receive and pay for health insurance has been changing for more than 10 years

A call for child passenger safety

Dr. Michelle Macy, a 2013 CHRT Policy Fellow, wrote an opinion piece in the Detroit News which argues that Michigan’s Child Passenger Safety Law has not kept pace with recent research and recommendations from the American Academy of Pediatrics. Dr. Macy states that we should require rear-facing car seat use beyond 1 year —and booster seat use until the until the vehicle seat belt fits properly, which is usually is when a child is, on average, 11 years old. She urges the legislature to consider updating the law, noting that child safety should be a bi-partisan issue.

Understanding the Affordable Health Care Act

Amy Lange with Fox 2 News sits down with CHRT Director Marianne Udow-Phillips to find out what consumers need to know about the Affordable Care Act before the new health insurance exchanges launch Oct. 1.

A lesson from Massachusetts: Biz, government should work together

Among the coverage in a Crain’s Detroit Business special section aimed at educating employers and employees on the coming changes under the ACA is a retelling of a previous article summarizing CHRT’s Massachusetts Comes to Michigan: Lessons about Health Care Reform from Business Leaders symposium in February 2013.

Health care changes: Thousands in Washtenaw County to be eligible for Medicaid, other subsidies

CHRT and the Washtenaw Health Initiative are center stage (and front page) in the newly (re)launched Ann Arbor News. The article looks at what the Affordable Care Act means for Washtenaw County residents and where—and who—they can go to for help.

What can Michigan residents expect from the Affordable Care Act?

CHRT Director Marianne Udow-Phillips speaks with Cynthia Canty, host of Michigan Radio’s Stateside, about what Michigan residents should know about the Affordable Care Act as the opening of the new health insurance exchanges nears.

6 things to know about healthcare changes in Michigan

What does 138 percent of poverty translate into in dollars? Michigan Radio refers to an earlier interview CHRT Director Marianne Udow-Phillips for the answer.

Recession, increase in uncompensated care severely strain Michigan’s health care safety net, says Center for Healthcare Research & Transformation

A report released today by the Center for Healthcare Research & Transformation (CHRT) outlines the severe impact of Michigan’s recession on the ability of the health care safety net to provide health care to the growing number of Michigan residents who need their services.

From 2007 to 2011, uncompensated care provided by Michigan hospitals increased 42 percent, and patient volume at federally qualified health centers (FQHCs) increased by 22 percent. The number of uninsured increased by 133,000, yet there was no net increase in the number of free clinics statewide. In fact, five of seven free clinics in the Upper Peninsula closed, leaving just two clinics for the entire population.

“These trends emphasize how important the Medicaid expansion in Michigan is in terms of access to care,” says Marianne Udow-Phillips, director of CHRT. “The demand for low and no cost care through federally qualified health centers has increased in Michigan. At the same time, some free clinics in the state have closed anticipating that Medicaid will expand. If the expansion does not occur, there will be further pressure on the FQHCs in the state to provide access or more care will likely be delivered at the nearest emergency room, further escalating the rate of uncompensated care that hospitals provide.”

The strain on the health care safety net results in cost shifting to private insurers, higher premiums, and a continuation of the cost/access challenges evident in Michigan and nationwide, says Udow-Phillips.

CHRT’s review of Michigan’s health care safety net includes additional findings, such as:

The Medicaid coverage rate increased steadily from 12.2 percent of the population in 2007, to 17.5 percent in 2011.
The number of patient visits for medical, dental, substance use and mental health care at FQHCs increased from 1.6 million in 2007 to nearly 2 million in 2011.
At FQHCs, mental health visits increased by 128 percent, far surpassing the increased visits for dental care (36 percent), medical care (21 percent) and substance use services (11 percent).
While the total number of free clinics remained at 75 across the state, the geographic distribution changed greatly. Southeast and Southwest Michigan saw increases in the number of free clinics, yet the Upper Peninsula lost seven of nine clinics.

The report also points to the gradual reduction of disproportionate share hospital (DSH) payments as a challenge for hospitals. These federal funds help compensate hospitals that care for a higher proportion of uninsured patients. Beginning in fiscal year 2014, these payments will be reduced and will eventually cease.

This publication is the fourth in the Cover Michigan 2013 series. Future publications will cover other aspects of health care in Michigan.

CHRT Projects Regional Impact of ACA, Medicaid Expansion Across Michigan

The Center for Healthcare Research & Transformation (CHRT), based at the University of Michigan, today issued projections on the likely coverage effects of the Affordable Care Act (ACA) in Michigan– both with and without an expansion of the Medicaid program. The projections focus on the adult population, aged 19-64, that will be eligible for Medicaid if the state approves its expansion and adults that will be eligible for tax credits to subsidize private coverage via the health insurance exchange.

“While there will be many people in Michigan who will be able to choose health plans through the new insurance exchanges starting this fall, most will continue to get their coverage through their employers or through Medicare or Medicaid,” says Marianne Udow-Phillips, director of CHRT. “If the state does expand Medicaid, we estimate that approximately 127,000 people will enroll in health plans through the new insurance exchange and, 320,000 additional people in Michigan will become covered by Medicaid.”

CHRT’s research describes the expected characteristics of those who are eligible to get coverage in Michigan as a result of the ACA, including geographic distribution, current coverage, age, gender, employment, education and race/ethnicity.

“Our research shows that access to affordable health coverage is a statewide issue. After Wayne County, four of the five top regions in the state that had the highest rates of uninsurance in 2011 were rural counties in the northern Lower Peninsula and the eastern Upper Peninsula. ”

CHRT’s research and projections show that:

More than one in six Michigan adults was uninsured in 2011. Michigan had 1.1 million uninsured adults in 2011 aged 19-64. Access to coverage varies by region and income level. Wayne County, including Detroit, plus rural regions in northern Lower Michigan and the Upper Peninsula had an uninsured rate of 20 percent or greater. Washtenaw County at 11 percent had the lowest rate of uninsured.
With Medicaid expansion, 93 percent of Michigan’s uninsured would have an affordable coverage option by 2019 via either Medicaid or exchange-based tax credits. By 2019, the uninsured rate in Michigan could be expected to drop from its current rate of 13.6 percent to 6 percent.
Without Medicaid expansion, 40 percent of the state’s 1.1 million uninsured would be left without an affordable coverage option, including those below 100 percent of the federal poverty level. With the simplification of the Medicaid enrollment process under the ACA – but without expansion – Medicaid enrollment by adults and children could be expected to increase gradually by 60,000 by 2019. Without expansion, in 2019, the uninsured rate in Michigan could expect to still be 10 percent (830,000 non-elderly adults).
Under the ACA without Medicaid expansion, the percentage of the uninsured that will be eligible for tax credits varies by region from a high of 59.4 percent in Midland and Bay Counties to a low of 36.5 percent in Wayne County including Detroit. Those below 100 percent of the federal poverty level, the poorest of the poor, would not be eligible for a tax credit whether or not Michigan decides to expand Medicaid.
Employer-sponsored health coverage will continue to be the dominant source of coverage in the state whether or not Michigan decides to expand Medicaid.

CHRT is issuing three research briefs as part of its Cover Michigan Survey 2013 series: “The ACA’s Coverage Expansion in Michigan: Demographic Characteristics and Coverage Projections”, “Regional Variation of the ACA’s Coverage of the Uninsured in Michigan”, and “The Uninsured in Michigan.” Copies of the briefs are available at chrt.test.