Publications

Comparing Recent Health Care Proposals: From building on the ACA to Medicare for All

Democratic lawmakers in Congress have made a variety of proposals to strengthen or reform the United States health care system. These proposals range from building upon the Affordable Care Act (ACA) to fully transitioning the U.S. to a single-payer system.

This fact sheet categorizes and compares the major provisions of these proposals, including possible implications for consumers, health care providers, and federal and state governments.

Read Comparing recent health care proposals: From building on the ACA to Medicare for All.

Projected Impacts of Medicaid Work Requirements: An Overview of Current State Proposals

As of January 2019, 14 states have submitted proposals to the federal government requesting permission to establish work requirements in their Medicaid programs. To date, the U.S. Centers for Medicare and Medicaid Services (CMS) has approved Medicaid work requirements for seven states, and two states (Arkansas and Indiana) have begun implementing these requirements for Medicaid beneficiaries.

In June 2018, Michigan enacted work requirements for many enrollees in the Healthy Michigan Plan (HMP), Michigan’s expanded Medicaid program for low-income adults.

Beginning in January 2020, HMP enrollees under age 63 will be required to report 80 hours of work per month or obtain an exemption (see CHRT’s previous fact sheet, Proposed Medicaid Work Requirements in Michigan).

The Michigan House Fiscal Agency initially estimated that approximately 80 percent of enrollees would be subject to the requirements, while 20 percent would qualify for an exemption.  More recently, an independent analysis by Manatt Health projected that 39 percent of HMP enrollees would be automatically exempt (based on age, pregnancy, medically frail, or incarceration status; or because they are already meeting SNAP/TANF work requirements), while 61 percent would be required to report work hours or obtain an exemption. This analysis estimated that 9 to 27 percent of all HMP enrollees could lose coverage over a one-year period.

Read Projected Impacts of Medicaid Work Requirements in Michigan.

 

Michigan at a Crossroads

Michigan’s Key Health Policy Issues, 2018

The Michigan government has jurisdiction over a wide array of health policy issues. From the regulation of insurance products, to oversight of the state’s Medicaid program, to investing in local public health efforts, Michigan policymakers craft policies and budgets that impact the health of millions of Michiganders.

This brief will provide an overview of four key and timely health policy topics: Medicaid and the Healthy Michigan Plan; the individual health insurance market and the Health Insurance Marketplace; the opioid epidemic; and integration of services to address social determinants of health. It will explore some of the forces influencing our state’s health and discuss policy approaches to today’s health and health care issues.

Read the full brief.

 

Proposed work requirements for Medicaid in Michigan June 7, 2018

At the start of 2018, the U.S. Centers for Medicare and Medicaid Services (CMS) announced a major shift in federal policy that would allow states to request permission to establish, and test the impact of, work and community engagement requirements for able-bodied adults receiving Medicaid health insurance coverage. In the last five months, work requirement proposals have been approved in four states; formal applications have been submitted by seven more; and a number of others are preparing proposals.

In April, the Michigan State Senate took the first step toward establishing work requirements by passing Senate Bill 897. The Michigan House of Representatives passed an updated version of the bill on June 6. And on the morning of June 7, the Michigan Senate approved the revisions and sent the bill to the Governor’s office for signature.

Read the full brief, Proposed Work Requirements for Medicaid in Michigan (June 7, 2018)

Setting the stage for the 2019 Health Insurance Marketplace

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The Centers for Medicare and Medicaid Services is rolling back regulations around rate increases, essential health benefits, health insurance navigators, and more, for insurers offering Qualified Health Plan coverage on the Health Insurance Marketplace in 2019.

In a new fact sheet, CHRT compares the current rules and regulations to the changes that go into effect in 2019—with a special focus on Michigan. Here are just a few highlights:

  • Rate increases under 15 percent will no longer require review;
  • Simple choice standardized plans will be eliminated; and
  • Consumer cost-sharing limits will increase by 7 percent.

These changes will impact Michigan consumers as soon as November 1, 2018, when the next Marketplace Open Enrollment Period begins.

For more about silver loading, individual mandate hardship exemptions, risk adjustment rules, and other regulatory changes, read the full brief.

 

Proposed work requirements for Medicaid in Michigan (April 20, 2018)

At the start of 2018, the U.S. Centers for Medicare and Medicaid Services announced a major shift in federal policy that would allow states to request permission to establish, and test the impact of, work and community engagement requirements for able-bodied adults receiving Medicaid health insurance coverage. In the last three months, work requirement proposals have been approved in three states; formal applications have been submitted by seven more; and a number of others are preparing proposals.

In early March, Michigan state senators took the first step toward preparing a work requirement proposal of their own by introducing Senate Bill 897. The bill passed the Michigan State Senate on April 19. In this fact sheet, we compare the characteristics and projected impact of Michigan’s work requirement proposal against the characteristics and projected impact of approved work requirement proposals in Kentucky, Indiana, and Arkansas.

Read the full brief, Proposed Work Requirements for Medicaid in Michigan (April 20, 2018).

 

Changes in Primary Care Physicians’ Patient Characteristics Under the ACA

 

When the Affordable Care Act (ACA) passed in 2010, health analysts expressed concerns that the expansion in coverage, predominantly through Medicaid and the Health Insurance Marketplace would overload the health system and cause problems with access to care. Seven million Americans live in areas where demand for primary care may exceed supply by more than 10 percent. An estimated 20 million people have gained insurance coverage nationally since the ACA’s major coverage provisions went into effect in 2014, including more than 14 million in Medicaid and CHIP, as of March 2016.[

In Michigan, insurance coverage increased from 89.0 percent in 2013 to 94.6 percent in 2016. A survey of Michigan primary care doctors shows that the fears of overwhelming the health system have largely not come true. This brief looks at what Michigan primary care physicians (PCP) say about the impact of the coverage expansion on their practices.

To learn more, read Changes in Primary Care Physician Patient Characteristics Under the Affordable Care Act.

Health Insurance Marketplace in Michigan 2018: Rate Analysis

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In 2017, the federal government took several regulatory and administrative actions that affect the health insurance marketplaces created under the Affordable Care Act (ACA). At the same time that Congress considered legislative proposals to repeal and replace the ACA, the U.S. Department of Health and Human Services (HHS) promulgated new regulations that changed annual open enrollment dates and announced the end of cost-sharing reduction payments to insurers. These developments, in addition to several other factors, have impacted Marketplace carrier participation and plan pricing in Michigan.

Key Findings

  • Michigan continues to have a robust Marketplace. Eight insurers are participating in Michigan’s health insurance marketplace in 2018, a decrease of two insurers from 2017.
  • Michigan consumers can select from a variety of Marketplace plans. There are 12 to 52 plans offered in each of Michigan’s 83 counties.
  • Across all counties, the average premium increase for the lowest cost and second-lowest cost silver plans is 33 percent and 34 percent, respectively. Premiums for the lowest cost bronze plan increased by 16 percent, and premiums for the lowest cost gold plan increased by 6 percent.
  • Premium tax credits are linked to the cost of the local second-lowest cost silver plan. All else equal, individuals who are eligible for premium tax credits could receive a larger tax credit in 2018 due to premium increases for the second-lowest cost silver plan. In 23 counties, larger tax credit amounts will eliminate the cost difference between renewing the 2017 lowest cost silver plan and actively enrolling in the 2018 lowest cost silver plan.
  • The federal government reduced the open enrollment period to 45 days, from 92 days in 2017.
  • Federal financial support for Michigan Navigators to help with open enrollment has been reduced by 72 percent, from $2,228,692 in 2017 to $627,958 in 2018.

For more, read Rate Analysis: 2018 Health Insurance Marketplace.

Comparing Key Provisions: Affordable Care Act, American Health Care Act, and the Graham-Cassidy Proposal

In July 2017, the United States Senate rejected a series of proposals to repeal and replace the Affordable Care Act (ACA). On September 13, 2017, Senators Lindsey Graham and Bill Cassidy introduced a new proposal to repeal and replace the ACA.

The Graham-Cassidy proposal retains some similarities to the American Health Care Act, which passed the U.S. House of Representatives in May 2017, but includes some notable differences. The following table compares key provisions of the Affordable Care Act, American Health Care Act, and the Graham-Cassidy proposal.

The Senate has until September 30, 2017 to pass a repeal and replace package under the Fiscal Year 2017 budget reconciliation process, which requires a simple majority for passage. After the end of FY 2017, any repeal and replace legislation would most likely require 60 votes for passage.[footnote]It is possible that budget reconciliation, requiring a simple majority for passage, could be used for repeal and replace legislation in FY 2018 if it is not used for other issues.

On Sept. 25, the U.S. Congressional Budget Office (CBO) issued a preliminary report on a version of the Graham-Cassidy bill summarized in this brief. The CBO concluded that the bill would save at least $133 billion. However, it would result in millions of people losing health insurance. Additional, detailed analyses may be forthcoming.

Read more in Comparing Key Provisions: Affordable Care Act, American Health Care Act, and the Graham-Cassidy Bill.

The Impact of the ACA on Community Mental Health and Substance Abuse Services: Experience in 3 Great Lakes States

The Affordable Care Act (ACA) allowed states to expand Medicaid coverage to low-income childless adults, many of whom receive specialty mental health and substance use services through community mental health systems.  Leading up to the passage of the ACA, community mental health providers and their professional associations were generally supportive of expanding Medicaid under the ACA.  Medicaid covers specialty services central to quality mental health and substance use care, as well as other physical health services that many in the serious mental illness (SMI) and substance use disorder (SUD) populations lacked before 2010.

To date, 32 states have expanded Medicaid (including the District of Columbia), while the remaining 19 have not.  This brief, which was developed with support from the Commonwealth Fund, examines the impact of the ACA on public mental health and substance use systems in three Midwestern states: Michigan and Indiana, both Medicaid expansion states, and Wisconsin, a non-expansion state.

The experience from these three states suggests that Medicaid expansion has had an important and overall beneficial effect in particular for the substance use population.  The favorable impact is particularly important in light of the opioid epidemic.

Read The Impact of the ACA on Community Mental Health and Substance Abuse Services: Experience in 3 Great Lakes States.