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Cover Michigan 2010 is CHRT’s annual report of health care coverage in the U.S. and Michigan, including data on the uninsured, publicly and privately insured, premiums and cost-sharing, the health care safety net and, new for this year, health reform (also available separately in the CHRT Issue Brief, Impact of Health Reform on Coverage in Michigan).

Cover Michigan 2010 presents the most recent comparative data available for the U.S. and Michigan: 2008 data for the U.S. and 2007/2008 two-year pooled data for the state. Michigan data are pooled to ensure an adequate sample size; some demographic data are reported as three-year pooled averages. Where possible, more recent data are included.

The report and the Cover Michigan Survey 2010 (released in March 2010) both reveal continued upward trends in areas of concern from our 2009 report: more people lacking insurance, more employers dropping coverage, higher costs for those who have insurance, and a growing strain on the health care safety net.

Important trends noted in Cover Michigan 2010 include:

The numbers of uninsured and publicly insured in our state have been growing. More than 3.8 million Michigan citizens were either uninsured or covered by a public program (Medicare, Medicaid, military)—almost 39 percent of the state’s population;
Despite the growth in public coverage, many of the poor did not have coverage at all: 37 percent of those with incomes below the poverty line did not have coverage in 2007/2008;
While Michigan still has a higher percentage of those with private coverage than most states (ranking ninth highest), businesses in Michigan have been dropping coverage at a faster rate than the U.S. overall and the percent of Michigan’s population with private coverage was 4.5 percent lower in 2007/2008 than it was in 2003/2004;
Average Michigan family premiums continue to be less than the U.S. average, at $11,321 compared to $12,298— making Michigan the ninth lowest state in average family premiums in 2008;
Reflecting the increase in the number of uninsured in the state and the increase in copayments and deductibles faced by those with insurance, uncompensated care in hospitals increased in 2008 to $2 billion, a 94 percent increase since 2004;
“Safety net” providers in Michigan are critically important for many of those most in need, but these providers are challenged to meet demand for their services. Also, Michigan has fewer such providers than many other states: Michigan ranked 31st in the nation for the number of federally qualified health center sites per 10,000 uninsured.

We predict these 2008 trends will continue in the 2009 data. If anything, given the dramatic economic events of 2009, they will likely reflect even steeper changes in the same directions. There is no question the trends evident in this report depict both the reasons health reform was a major national policy issue in 2009 and some of the challenges it will face.

READ THE BRIEF

In January of 2009, CHRT released the first edition of Cover Michigan, a report designed to provide a comprehensive picture of health care coverage in the U.S. and Michigan. In August 2009, to better understand the impact of coverage trends on the people behind the statistics, CHRT commissioned a survey of 1,022 Michigan adults about their sources of coverage, perceived health status, ability to pay for insurance and care, and decisions about seeking—or not seeking—needed health care services. Significant findings from the 2010 Cover Michigan Survey survey include:

Income—not coverage status—was the single most important factor influencing self- perceptions of health. Seventy-two percent of those with incomes of $150,000 or more reported excellent or good health, compared to just 14 percent of those with incomes of less than $10,000 per year. Coverage status, however, wasn’t key to self-perceptions of health, with 49 percent of those who were insured reporting excellent or very good health, compared to 47 percent of the uninsured.
Cost was an issue for both the uninsured and the insured. Of those who were uninsured, 29 percent reported they lacked coverage because they could not afford to pay for it; only 4 percent said they did not have coverage because they were in good health. Forty percent of those who were uninsured reported delaying needed medical care in the six months preceding the survey. Seventeen percent of those with insurance delayed seeking needed medical care—a lower percentage than the uninsured but substantial nevertheless. For both groups, cost was cited as the number one reason for delaying needed medical care.
Urban dwellers, despite having the lowest average incomes, reported fewer problems with access to care than all but suburban dwellers with the highest average incomes. Sixteen percent of urban dwellers reported delaying needed medical care in the past year, compared to 10 percent of suburban dwellers. This finding is likely related to the fact that urban communities generally have more safety net providers than other geographic settings.
More than one-third of all Medicaid recipients reported having a hard time finding health care providers. Thirty-five percent of those covered by Medicaid or Healthy Kids said they had difficulty finding providers who would accept their coverage. In contrast, only 12 percent of those with MIChild coverage reported difficulty accessing needed care.
Those with jobs in manufacturing expressed considerable worry that they might lose health insurance coverage, joining those in the retail and service sectors, who have traditionally expressed such concerns. Those with jobs in manufacturing, services, the arts, and the wholesale/retail trade were the most worried about losing health insurance; those with jobs in information technology, government, construction, and education were the least worried.

Taken together, the findings from the Cover Michigan Survey 2010 paint an important picture for those seeking to expand access to care in Michigan and the U.S. While health insurance coverage for all is an important goal, this survey reveals that coverage alone will not guarantee access to care. Other barriers to access—such as cost and availability of providers—must be addressed by policy makers in all sectors in order to close the gap between coverage and care. And, factors beyond medical care—such as income and education—must be considered if the focus is on achieving the ultimate goal: improved health status for all Michiganders.

READ THE BRIEF

Suggested citation: Riba, Melissa, Nathaniel Ehrlich, Marianne Udow-Phillips, Karen Clark, and Jody Myers. Cover Michigan Survey 2010. Ann Arbor, MI; Center for Healthcare Research & Transformation, 2010.

Photo Credits: Daymon J. Hartley © 2010 daymonjhartley.com Special thanks to Natasha, Jayden, Zack, and Connie for sharing their health care stories and agreeing to be photographed for our publication.

The staff of the Center for Health Care Research & Transformation (CHRT) would like to thank the staff of the Institute for Public Policy and Social Research (IPPSR) at Michigan State University for their assistance with the design and analysis of the survey.

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