Obamacare repeal effort threatens Healthy Michigan: Governor struggles to preserve signature healthcare program

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No matter how Republicans in Congress try to spin it, it seems the majority of their constituents know the difference between when their elected officials are trying to screw them and when they are actually trying to do the right thing. A recently released poll shows that most Americans have little to no faith in the proposed American Health Care Act (AHCA) legislation, otherwise known as Replace and Repeal, that the Republicans in the House are putting forward. So much so, in fact, that Republicans in the Senate had been essentially declaring the House proposal dead on arrival and didn’t even want to be associated with it. This week, however, according to an article in Politico, it appears the Senate may be inching closer to finding a way to make America sick again thanks to Sen. Mitch McConnell.
But even before this whole thing got started, back when Trump was just Trump and we had an actual President of the United States doing presidential things without having to worry about being brought up on charges, and back when the Republicans were totally united in their desire to dismantle Obamacare, Michigan had a slightly different approach which, unlike most other states overseen by Republican governors, actually understood the value of not letting its residents die from lack of affordable and accessible health care.
Recognized now as something of a Republican alternative to Obamacare (waivers were required for how the state implanted Medicaid expansion), Healthy Michigan supported the idea of helping Michigan residents get the health care they needed, but with some Republican-style ideas thrown in added in such as requiring more personal responsibility in the process. Obviously it’s much more complicated than that overall, but the idea seemed to be that this was a proposal that could be sold as a Republican effort that would not completely and totally reject Obamacare simply because the name ‘Obama’ was in there somewhere.
By most indications, the program has been very successful. Lord knows I’ve had more than a few strong – extremely strong – disagreements with Gov. Rick Snyder, but Healthy Michigan is not one of them. The overall idea and implementation of this program displayed a willingness to compromise in favor of Michigan citizens and not simply jump on the GOP self-destruct bandwagon for appearances sake, and that’s a good thing.
Which is why it is no small reason for concern that the proposed GOP House bill, if it ever turns into law, has the potential to effectively wipe out Healthy Michigan. Granted, the polls show opinion is strongly against the Republican House proposal, and the Senate doesn’t appear to be much in favor either, not to mention the fact that Trump is somewhat preoccupied right now trying to dodge all the evidence threatening to expose him as the clear and present danger to national security that he truly is.
From CNBC, posted on May 26:
“One new poll found that just 20 percent of voters said they would be more likely to vote for a senator or member of the House who supported the current version of the bill. But 44 percent of voters they they would be less likely to vote for a member of Congress who backed the bill, according to that poll from Quinnipiac University.
“The same Quinnipiac Poll found that 57 percent of voters disapprove of the bill, known as the American Health Care Act. Just 20 percent of voters approve of the bill.”
But it ain’t over ‘til it’s over, which means there is still too much of a chance that the fervor on Capitol Hill to obliterate Obamacare and fulfill Trump’s campaign promise – and the promise of Republicans everywhere since Obamacare became law – could overtake common sense and erase the progress that has been made rather than build on that progress by repairing the evident flaws of Obamacare.
In Michigan, the repeal of Obamacare could have drastic consequences. And if it’s drastic for Michigan overall, you know what that means for Detroit and Wayne County. Michigan Health and Human Services Director Nick Lyon has said that it would cost the state an estimated $800 million annually to continue the Healthy Michigan program if the GOP healthcare repeal legislation goes through and federal funding is reduced to the standard matching rate for other Medicaid enrollees.
More specifically, if the House bill became law, then the concern focuses on a provision in Michigan state law requiring the program to be shut down once the overall cost of the program exceeds the savings generated. What happens in the House bill is that starting Jan. 1, 2020, individuals who leave the program and then return later come back on at a different matching rate where the federal government doesn’t contribute as much. That becomes a new cost borne by the state.
If this is done across the entire Healthy Michigan population, and the state was going to keep Healthy Michigan in place and find the resources to do it, that would cost the state about $800 million per year. That is the result of going from a 90% matching rate to a 65% matching rate. So imagine that the federal government used to pay 90% of the cost, but now will only cover 65%, then spread that additional cost per enrollee across 670,000 Healthy Michigan enrollees, and BOOM. Budget buster.
Now let’s get specific to how this might affect us locally.
For Wayne County, as of two weeks ago there were 186,000 individuals enrolled in Healthy Michigan. Of that 186,000, more than 90,500 are enrolled in Detroit.
According to a University of Michigan study, health service providers have seen a 50 percent reduction in the cost of uncompensated care since the implementation of Healthy Michigan. This means that half of the folks who used to show up at hospital emergency rooms without any insurance to get care, passing on those costs to the hospitals, has decreased by 50%. Suffice to say that this had been a problem in black and poor  Detroit for quite some time.
More statewide survey stats:

  • Before Healthy Michigan, 16% of the folks enrolled were using the emergency rooms as their regular source of primary care. That has dropped from 16% to 1.7%.
  • Roughly 65% of enrollees are able to get in to see a primary care doctor within 150 days. That is a turnaround from the days when folks who didn’t have insurance weren’t even going to see a primary care doctor.
  • 590,000 enrollees have had a primary care visit.
  • Over 250,000 mammograms have been covered.
  • 320,000 enrollees have received a dental visit
  • 55,000 enrollees have been screened for colon cancer

Today, 50% of all births in Michigan are covered by Medicaid. Almost 50% of Michigan’s kids are on the Medicaid program. Two-thirds of all nursing home beds are supported by Medicaid.


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