Policy Archives

Health Insurance Marketplace in Michigan 2018: Rate Analysis

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. This brief analyzes the rates in the 2018 Health Insurance Marketplace in Michigan.

Key findings include:

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.

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ACA Repeal and Replacement: Proposals and Action

Beginning last month, both U.S. President Donald Trump and the U.S. Congress began taking steps to repeal and replace the Affordable Care Act (ACA). However, a single replacement strategy has not yet emerged.

In a new one-page fact sheet, CHRT summarizes the most developed ACA repeal and replacement proposals offered to date and outlines the tentative replacement process.

You can also review CHRT’s companion piece, Select Affordable Care Act Replacement Plans and Implications, for a detailed table summarizing the key features and implications of the most developed full ACA repeal and replacement plans offered to date.

The face sheet summarizes three full replacements for the ACA: the House Republicans’ “A Better Way” proposal, Rep. Tom Price’s “Empowering Patients First Act”, and the Burr-Hatch-Upton “Patient Choice, Affordability, Responsibility, and Empowerment Act”. It also summarizes one partial replacement, the Cassidy-Collins “Patient Freedom Act”.

The fact sheet also details the process to repeal and replace the ACA. We summarize President Trump’s January 20 Executive Order and the 2017 Congressional Action. On January 3, the Senate Budget Committee created a budget resolution to provide framework for a partial ACA repeal using budget reconciliation. On January 12 the resolution received full Senate approval and on January 13 it received full House approval.

The House and Senate committees intended to have draft actual reconciliation legislation by January 27, but this has been delayed. April 15 is the prescribed deadline under current rules for the House and Senate to adopt annual budget resolutions, but this is generally not enforced. June 15 is the prescribed deadline to enact any reconciliation legislation, but this is also generally not enforced.

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An in-depth look at six cost containment programs in the Affordable Care Act

This paper describes six cost-containment policies or initiatives included in the Affordable Care Act (ACA) that target how health care is delivered and the growth of health care costs. A summary of the implementation occurring in Michigan is also provided.

The policies or initiatives explored in depth here are:

Accountable Care Organizations
Hospital-Acquired Conditions
Value-Based Purchasing
Hospital Readmission Reductions Program
Center for Medicare and Medicaid Innovation
Program Integrity

An accountable care organization (ACO), for example, is a network of providers clinically and financially responsible for the entire continuum of care for a group of patients. Depending on the arrangement, providers, hospitals, and health insurers may share responsibility for the patient’s care. Following the passage of the ACA, the Centers for Medicare & Medicaid Services (CMS) began developing programs for Medicare providers using the ACO model

There has been much discussion of the coverage provisions of the ACA but the law also includes robust cost containment provisions. Although each of the policies highlighted here is in nascent stages of implementation, all are premised on prior demonstration programs or experiments in the public and private sectors. Evidence currently available for these policies and initiatives, such as the ACOs discussed earlier, currently points to moderate effectiveness in reducing costs, and at least some successes in improving quality. Many of these initiatives may be synergistic, together creating a more significant effect on the delivery system than each individually.

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Cost containment in the Affordable Care Act: An overview of policies and savings

While there has been considerable media coverage about the insurance impacts of the Affordable Care Act (ACA), there has been less discussion of the law’s changes to provider reimbursement policy, reforms to the delivery system, and investments in programs to improve the quality of care and constrain long-run growth in health care expenditures. And yet, the elements included in the ACA directed at cost and quality are likely to affect the practice of care for nearly every provider across the country.

This paper focuses on ACA cost-containment policies that target the delivery of health care at the provider level, and aim to reduce system-wide health care costs—for the federal and state governments, individuals, and employers—through delivery system reforms.

This paper first describes the categories of policies in the ACA designed to contain costs. It then provides an overview of several policies in each category that are expected to reduce the rate of growth in costs.

A companion paper, An in-depth look at six cost containment programs in the Affordable Care Act, provides a more detailed description of six specific policies or initiatives designed to affect system-wide growth in health care costs.

The ACA policies aimed at transforming the quality, delivery system, and payment structure of health care will have long-term impacts, but it is unclear when the projected cost-savings of those policies will be realized. In 2012, health care spending grew by 3.7 percent, a record low pace for the fourth consecutive year.11 Some analysts attribute the slowed growth in health care spending to the Great Recession, and argue that rapid growth in health care spending will likely return as the economy recovers.

Others have suggested that changes to the health care system, including those made by the ACA, contributed to the slowed growth in spending. Analysis by the Kaiser Family Foundation and the Altarum Institute in April 2013 indicated that most (77 percent) of the recent decline in health spending growth can be attributed to changes in the broader economy, with the remaining 23 percent attributed to changes in the health care system such as increased cost sharing and changes in payment and delivery systems. Both organizations concluded that spending will increase as the economy recovers and that temporary increases are likely to occur as individuals previously uninsured gain coverage; however, these analysts consider the return of double-digit growth unlikely.

Most recent data indicate that increases in health care spending are no longer on a downward trend but have returned to pre-recession rates. The Altarum Institute reported that health care spending grew by 6.7 percent in February 2014, the highest level since March 2007.

The impact of the ACA on cost is not completely clear, especially considering the major implementation activity in 2014. The impact of the ACA’s many provisions aimed at moderating costs will be measured and become clearer over the coming years.

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Primary care capacity and the Affordable Care Act: Is Michigan ready to expand Medicaid coverage?

Since one of the most immediate questions facing the State of Michigan is whether to expand Medicaid coverage, this issue brief focuses specifically on one area of inquiry—Michigan primary care physicians’ capacity to serve new patients in both Medicaid and the private insurance market.

In the fall of 2012, the Center for Healthcare Research & Transformation (CHRT), in partnership with the Child Health Evaluation & Research Unit (CHEAR) at the University of Michigan, conducted a statewide survey of primary care physicians. The purpose of the survey was to understand the challenges and opportunities primary care physicians are facing in their practices in this era of health care reform.

Our goal was to inform policymakers about a number of key issues ranging from meaningful use of electronic health records to the capacity to care for Michigan residents, especially in light of the expected significant growth in insurance coverage beginning in 2014.

The bottom line of the survey is that primary care physicians in Michigan overwhelmingly anticipate having the capacity to serve more patients with all forms of health coverage, including Medicaid.

Overall, 81 percent of primary care physicians anticipate expanding their practices to include newly insured patients. Of those physicians, 90 percent of pediatricians; 78 percent of internal medicine practitioners; and 76 percent of family physicians reported that they will have capacity to accept additional patients if the number of Michigan patients with insurance coverage increases in the future.

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Suggested citation: Davis, Matthew M.; Udow-Phillips, Marianne; Riba, Melissa; Young, Danielle; Royan, Regina. Primary Care Capacity and Health Reform: Is Michigan Ready? January 2013. Center for Healthcare Research & Transformation. Ann Arbor, MI.

Special thanks to the Michigan State Medical Society and the Michigan Osteopathic Association in survey development, and to Krishna Davis, Seetha Davis, Lakshmi Halasyamani, Brandon List and Rose Kenitz for data entry.

The path to health care coverage under the Affordable Care Act: A flow chart

Following the U.S. Supreme Court’s decision to uphold the constitutionality of the Patient Protection and Affordable Care Act (ACA), efforts continue at the state and federal levels to prepare for implementation of key provisions of the ACA scheduled to take effect in 2014. These provisions, such as the (now optional) Medicaid expansion, the individual mandate to purchase insurance, state insurance exchanges, and employer “play or pay” rules will create new or different pathways to health coverage for many after the ACA comes into effect.

This flow chart provides a high-level picture of the ways that people will obtain health coverage in 2014, assuming the ACA is implemented as it exists today. The flow chart clearly reflects the complexity of the existing system for health coverage in the U.S., a public/private hybrid the ACA builds upon, but does not fundamentally change.

This diagram is intended as an overview of the pathways to coverage: while individuals may follow the flow chart to determine possible options, it is not intended to be comprehensive for that purpose. Rather, it is offered as a way to look ahead and better understand the many pathways to coverage that will exist in 2014, specifically in states that accept the option to expand Medicaid eligibility to individuals and families with incomes up to 138 percent of the federal poverty level (FPL).

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Updated February 12, 2013.

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