Michigan

2018 MIDTERM ELECTION

Time: D H M S

Aside from Virginia, it's likely going to be another month or so before the 2019 ACA policy rate filings start trickling in, since the deadline for initial rate requests isn't until late June in most states. However, there's some interesting non-ACA policy filing stuff which is available as well. Given all the concern about non-ACA compliant policies siphoning healthy people away from the ACA market, I figured I should take a look at a few of these.

Here in Michigan, I've found three such filings: One is for "transitional" plans from Golden Rule (a subsidiary of Unitedhealthcare, I believe). The other two are for "short-term" plans (the type which Donald Trump is basically removing any regulation on).

First up, Golden Rule:

I've written quite a bit about the attempt by the GOP-controlled state legislature to push through work requirements for ACA Medicaid expansion here in Michigan. The bill (SB897) was quickly passed on partisan lines in the state Senate last week, and has now been taken up by the appropriations committee in the state House.

I actually shlepped my butt all the way out to Lansing yesterday morning to attend the committee hearing. Unfortunately, there were so many others who wanted to speak during the Public Comment period, I didn't get a chance to chime in.

Anyway, during the hearing, there was a reference to one provision of the proposed Senate version of the bill which caught my attention:

NOTE: Just to clarify, here's where the headline comes from:

...Sponsoring Sen. Mike Shirkey, R-Clarklake, created exemptions in the Michigan legislation that would waive the work requirement for parents with young children, pregnant women or caretakers for disabled family members. But asked about people like Maitre who could still lose health care, he told reporters the social safety net “by definition, has a lot of holes in it.”

“The best safety net ever invented by God is family,” Shirkey said, “but I’m not sure that government is supposed to supplement that process.”

Well, here we go:

#BREAKING tomorrow morning the House Appropriations Committee is taking up SB 897. Another Republican attempt to take away healthcare from Michigan families https://t.co/WsUhyntINj

— MI House Democrats (@MIHouseDems) May 2, 2018

As noted earlier, I've been a bit lax with posting for a few days as I've worked on my latest 2-part video explainer about risk pools and #ShortAssPlans.

However, there's been a lot going on, so I figured I should try and at least do a quick update on a few items. First up: Medicaid expansion!

Here in my home state of Michigan, I've written several posts about how the GOP-controlled state legislature trying to shove through a draconian "work requirement" bill for Healthy Michigan, our name for ACA Medicaid expansion program which has been working just fine, thank you very much, for nearly 5 years now. The bill easily passed the state Senate (where the GOP holds a supermajority), and is now under consideration by the state House (where they have a smaller but still solid majority at the moment). The good news is that GOP Governor Rick Snyder--who championed passage of Healthy Michigan in the first place and seems to think it's fine mostly the way it is--is likely to veto the senate version of the bill. The bad news is that it might simply be tweaked somewhat by the House.

As I noted last week, the Republican-controlled Michigan state Senate rammed through a draconian work requirement bill for ACA Medicaid expansion enrollees in spite of the fact that it would serve no positive purpose and would only "save money" by kicking thousands of low-income Michiganders off their healthcare coverage while actually harming the economy.

I further noted that while I was pretty sure the bill would easily pass the state Senate (where the GOP holds a supermajority) and will likely pass the GOP-controlled state House as well, there is a decent chance that it could be vetoed by GOP Gov. Rick Snyder. Snyder is guilty of a long list of sins during his time as Governor, including being indirectly responsible for the water supply for the entire city of Flint being poisoned a few years back. At the same time, oddly, once in a blue moon he'll actually do something decent and good, and the one he deserves the most praise for on this front is pushing to get Medicaid expansion through in the first place.

(sigh) Dammit, sure enough, as I expected, the full Michigan state Senate has gone ahead and passed the state Senator Mike Shirkey's "God's Safety Net" bill which would impose 29-hour-plus work requirements on 680,000 low-income Medicaid enrollees even though the vast majority of them already work, go to school, are medically fragile, take care of other medical fragile family members, elderly relatives or children and so forth. It was, as you'd expect, a party-line vote:

Able-bodied Medicaid recipients in Michigan may soon have to choose between finding a job or losing health insurance.

...Democrats condemned the proposal as harmful to thousands of Medicaid recipients who would not meet the several exemptions spelled out in SB 897 and said such a move is also illegal. Majority Republicans brushed aside those objections, and the bill passed 26-11.

The bill now heads to the House.

 

(sigh) This is so predictable...via Jonathan Oosting of the Detroit News:

...Maitre, 62, spends dozens of hours each week babysitting her grandchildren and providing their working parents with free child care. But none of that time or her community service would count as work under an advancing plan that would require Medicaid recipients to spend 29 hours a week at a job or risk losing their health care coverage.

...The Republican-led Senate Competitiveness Committee approved the legislation a short time later in a 4-1 vote. The lone committee Democrat voted against the plan to reform the government health care program for lower-income residents, which has grown significantly in recent years after the state expanded eligibility under former President Barack Obama’s signature health care law.

It now moves on to the full state Senate, as I expected.

This morning I was contacted on Twitter by a woman in Louisville, Kentucky who appears to be in pretty dire straits:

On 7/1/18, in Ky, my Medicaid/ ACA will be canceled. I may still need a brain shunt, LP #8, RXs, PT, etc. I was informed that my PCP could write a letter stating I was "Medically Fragile" but even then the provider has final say. Like fox guarding hen house. Please help me/DM

Here's her story according to her GoFundMe page (I've cleaned up the formatting a bit for easier readability):

I am a disabled attorney living with my 76-year-old mother who takes care of me. In 2011, I was bitten by a tick and was infected with Ehrlichiosis Chaffeensis and Rickettsia. A week later, I contracted Coxsackie B4 virus. Because I was kept on antibiotics for 19 years, I had no immune system to fight these illnesses.

As I noted last month, the Republican-controlled Michigan State Senate is planning on jumping on board the pointless, wasteful, cruel "work requirement" bandwagon which is all the rage among the GOP types these days.

Sure enough, they're planning on ramming it through within the next week: The Michigan Senate’s Competitiveness Committee is expected to hold a hearing on SB 897, a bill that would impose a work requirement on over 670,000 adult Michiganders with Medicaid health coverage...or nearly 7% of the state population.

The committee chair and the bill’s sponsor, Senator Mike Shirkey (SD-16) is planning on pushing the committee vote through ASAP and then kicking it over to the full state Senate right away.

UPDATE 4/11/18: I posted this piece about a month ago; I don't have any specifics, but I have reason to believe that the Michigan state legislature could be moving on this any day now. If you live in Michigan, CALL YOUR STATE SENATOR OR REPRESNTATIVE AND TELL THEM *NOT* TO IMPOSE WORK REQUIREMENTS ON "HEALTHY MICHIGAN" ENROLLEES!

h/t to Annette Prentice for the heads up on this. Via Michigan Public Radio:

State Senate introduces bill to add work requirements to Medicaid

The bill would require able-bodied adults to work or be in school for 30 hours a week in order to receive Medicaid.

Some lawmakers in Lansing want people to work to get Medicaid. The Senate introduced a bill Thursday. It would add work requirements to the Medical Assistance Program, or Medicaid.

...If passed, able-bodied adults would be required to work or continue school for 30 hours per week as a condition of receiving medical assistance.

I want to be clear about something: Much of my data analysis has a bit of snark to it, adding an acrid tinge of dark humor to healthcare, a topic which is often fraught with pain, suffering, grief and sadness. Once in awhile I take pause before twisting the sarcasm knife too much.

This is one of those moments. I'm therefore limiting the snark to the headline only.

From today's Detroit Free Press:

Three Januarys ago, Gov. Rick Snyder described a River of Opportunity all Michiganders could enter as long as the state improved third-grade reading proficiency.

“One of the important metrics in someone’s life on the River of Opportunity is the ability to be proficient-reading by third grade,” he said in January 2015. “How have we done? We were at 63% in 2010, and we are at 70% today. … But 70% doesn’t cut it.”

With the big news this week about CMS giving work requirements the green light and Kentucky immediately jumping all over it, I decided to look up a few data points from some expansion states which don't include a work requirement for the heck of it:

MICHIGAN:

  • As of January 8th, 2018, Michigan had 669,362 adults enrolled in the "Healthy Michigan" program (aka, ACA Medicaid expansion), or over 6.7% of the total population.
  • Men make up slightly more enrollees than women (51% to 49%)
  • Enrollees are spread fairly evenly by age brackets (19-24, 25-34, 35-44, 45-54 and 55-64)
  • Around 80% of MI expansion enrollees earn less than 100% of the federal poverty line; the other 20% earn between 100-138% FPL.

LOUISIANA:

  • As of January 8th, 2018, Louisiana had 457,178 adults enrolled in Medicaid expansion (nearly 9.8% of the population)
  • Women make up 62% of enrollees

As of December 4, 2017...

Happen to be in the Birmingham/Bloomfield area of Michigan on Monday, Jan. 8th? Swing by the Bloomfield Township Public Library at 1099 Lone Pine Road, Bloomfield Hills, MI 48302 from 7pm - 9pm, where I'll be giving the Birmingham/Bloomfield Democratic Club an overview of the ACA/healthcare landscape situation now that the dust has mostly settled on the 2018 Open Enrollment Period.

Given how much I've been shouting from the rooftops about the importance of everyone #GettingCovered the past month or so, I'm fully aware of the irony of what I'm about to say:

My wife and I finally #GotCovered this morning at HealthCare.Gov.

We logged into our current account, reviewed our options and in the end settled on...pretty much the same Gold HMO we already have today. It's actually a slightly different policy--Blue Care Network of MIchigan elimiated the "HMO Select" option and replaced it with the "HMO Preferred" option. As far as we can tell, the only differences are the (unsubsidized) premium price, which shot up by about $300/month (ouch.) and the deductible, when went up from $500 to $1,000.

For us, we had two major decisions to make: Gold vs. Silver...and (assuming we had gone with Silver), On-Exchange vs. Off-Exchange.

Until today, I operated under the assumption that my home state of Michigan was among the 18 states which took the "Silver Load" approach to dealing with the Cost Sharing Reduction (CSR) cut-off by the Trump administration. Reviewing the SERFF rate filings of the various carriers participating in the individual market, it looked like most of them were loading the CSR cost onto both on and off-exchange Silver plans. I didn't check every single carrier, but that seemed to be the trend, so I filed the state under "Silver Load".

HOWEVER, earlier today, commenter "Cayo" chimed in to say:

I'm signing up for a plan off the exchange with Priority Health in Michigan. ON-Exchange, the plan is $365 a month, but off exchange (directly from their website), the price is $300 per month. I don't qualify for a subsidy, but it's still cheaper than my 2017 plan with BCBSM. That was the Multi-State Plan in Region 7 with Dental and Vision.

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