2018 MIDTERM ELECTION

Time: D H M S

Michigan

Boy, all that fuss and arguing over the best path towards universal healthcare seems awfully silly this morning.

The Detroit Free Press, Tuesday evening:

Snyder to seek aid for Flint children exposed to lead

Michigan governor seeks to expand Medicaid to help at-risk young people exposed to lead in Flint during water crisis

Gov. Rick Snyder said Tuesday he will seek permission from the Obama administration to allow all young people in Flint the chance to receive publicly funded health care services for lead exposure amid the city's contaminated drinking water crisis.

...The White House and federal Department of Health and Human Services did not have an immediate response Tuesday to Snyder's initiative targeting Flint residents up to age 21 through the expansion of Medicaid.

 

Some readers may wonder why I, a lifelong Michigan resident who authors a website devoted to healthcare issues, haven't posted anything about my home state's latest shame, the Flint Water Poisoning scandal.

The answer is pretty simple: What the hell else is there for me to add? Our governor, Rick Snyder, along with a bunch of people at the top levels of his administration, who he appointed, appear to be guilty of, at best, criminal negligence (and at worst, potential negligent manslaughter) of the 100,000 citizens of Flint, Michigan...all in order to "save money". In fact, they were so intent on "saving money" that they didn't even bother to spend the $100 per day that it apparently would have cost to prevent hundreds or potentially thousands of children from suffering permanent physiological and mental damage.

Well, this is mostly good news, anyway. A week or so I reported that Michigan's version of the ACA's Medicaid expansion provision (called simply "Healthy Michigan") was at risk of having the plug pulled because a) it has to be re-approved by CMS and b) the revised version of the waiver includes some pretty draconian extra requirements.

The problem was that if CMS didn't approve the waiver, the entire program would be shut down, kicking some 600,000 Michiganders off their healthcare coverage next April.

Well, as Amy Lynn Smith reports via Eclectablog, CMS did end up approving the waiver after all, ensuring that the Healthy Michigan program continues for another few years:

CMS has approved the second waiver and the Healthy Michigan Plan will continue without any disruption.

Michigan Governor Rick Snyder had this to say in a statement:

Unlike the exchange QHP enrollments, which will always continue to be the heart and soul of this website (it's right there in the name, after all), I've kind of gotten away from trying to track Medicaid expansion on a granular level over the past few months. The main reason for this is that in many of the expansion states, they've simply maxed out on enrollees, and the numbers from week to week or even month to month are simply holding steady at this point.

This is the first post I've written since Friday, partly because I had my kid's Lego® Robotics League event all day Saturday, partly because I came down with a 24-hour (I hope) flu yesterday.

Anyway, some not-so-cheery news to report today:

MICHIGAN WAIVER PUTS CMS IN TOUGH SPOT — The federal waiver Michigan needs to extend its Medicaid expansion has put CMS in a bind — either approve controversial conditions or let the program end next spring. Pro’s Rachana Pradhan writes, “The 2013 Michigan law expanding Medicaid included a provision requiring CMS to approve a waiver with drastically conservative changes by the end of this year. The waiver would require Medicaid enrollees earning above the poverty line to make a choice after four years of Medicaid coverage: Either enroll in a private subsidized plan on HealthCare.gov, or stay in Medicaid and pay up to 7 percent of household income toward health care costs — notably higher than the 5 percent ceiling CMS has held other states to.” If the waiver isn't approved, Medicaid expansion coverage is scheduled to end in April.

Since today's just filled with wonderful news for 418,000 Kentucky residents who are very likely to lose Medicaid coverage, I figured I might as well toss this on the fire as well:

It appears that East Lansing-based Consumers Mutual Insurance of Michigan could wind down operations this year as it is not participating in the state health insurance exchange for 2016.

But officials of Consumers Mutual today are discussing several options that could determine its future status with the state Department of Insurance and Financial Services, said David Eich, marketing and public relations officer with Consumers Mutual.

Consumers Mutual CEO Dennis Litos said: "We are reviewing our situation (financial condition) with DIFS and should conclude on a future direction this week.”

Well I'll be damned. Given all the tea leaf/entrail-reading that I've had to do in some states to try and piece together the weighted average rate increases for 2016 (usually due to missing enrollment/market share data for the companies participating), it's a pleasant surprise to see that my own state of Michigan has posted the approved rate hikes without any gobbledygook:

Individual market to increase on average 6.5%, small group 1.0%

FOR IMMEDIATE RELEASE - August 18, 2015

LANSING - Michigan consumers and small businesses will experience lower increases in the cost of their 2016 health insurance plan than those in many other states, according to the Michigan Department of Insurance and Financial Services (DIFS). DIFS reports that the average approved rate changes on a premium weighted basis increased by 6.5 percent for the individual market and 1 percent for the small group market.

Nice job by Amy Lynn Smith over at Eclectablog today:

Once again, the Affordable Care Act (ACA) is proving its critics wrong. Opponents of the ACA, or Obamacare, have been falling all over themselves proclaiming that an influx of new patients will overburden the healthcare system, creating a dire doctor shortage.

At least in Michigan, that’s proven to be absolutely false.

A new University of Michigan study shows that the availability of primary care appointments actually improved for people with Medicaid in the first months after the state launched the Healthy Michigan Plan, the state’s Medicaid expansion under the ACA. What’s more, it remained mostly unchanged for those with private insurance.

This AP article provides snippets about a handful of states; it'd be nice if they just released the actual report so we could see the hard expansion numbers (as opposed to the total increase numbers, which are still obviously useful but don't distinguish between traditional Medicaid and ACA expansion enrollees):

In Kentucky, for example, enrollments during the 2014 fiscal year were more than double the number projected, with almost 311,000 newly eligible residents signing up. That's greater than what was initially predicted through 2021. 

...At least 14 states have seen new enrollments exceed their original projections, causing at least seven to increase their cost estimates for 2017, according to an Associated Press analysis of state budget projections, Medicaid enrollments and cost details in the expansion states. A few states said they could not provide original projections.

As I noted at the end of April, after climbing at a furious pace every week for months on end, Michigan's implementation of the Affordable Care Act's Medicaid expansion provision (aka "Healthy Michigan") plateaued at around 600,000 enrollees back in February, and then bobbled around the 600K level for several weeks straight. As I noted at the time, I'm still checking this figure weekly, but it has never deviated far from that number--sometimes a bit higher, sometimes lower.

As of June 30th, it stood at 606,779. 600K seems to be the level that ACA Medicaid expansion can be expected to stay at for the forseeable future.

So, with all the fuss & bother over the imminent King v. Burwell decision, what's the deal here in the Wolverine state?

Well, first of all, here's what's at risk if the Supreme Court rules for the plaintiffs, Congress fails to pass a simple tweaking of the law to resolve the issue and the state administration fails to "establish" an exchange which passes muster with regard to the minimum legal definition required:

Right off the bat, I want to clarify that I might have misread some of the numbers here; while some states provide the per-company average rate change requests in a nice, simple table format, I had to wade through a mountain of forms at the SERFF Filing Access Database to hunt all of these down, and there seems to be little consistency from company to company about the formatting of the documentation, etc etc. It's possible that I've confused a Small Group filing for an Individual one, for instance, and I may have misunderstood the current enrollment number for one or two companies. Finally, in one case (Physicians Health Plan), their 2016 rate request seems to have been redacted for some reason. Fortunately, they only appear to have around 600 enrollees anyway, which means any change in their rates would barely move the state-wide needle at all anyway.

With those caveats out of the way, assuming I have these numbers straight, here's what it looks like...and remember, these are requested changes only; they still have to be approved:

...it could actually be several hundred dollars lower.

A week ago I posted a story in which I busted Michigan State Senator Patrick Colbeck for blatantly spewing nonsense numbers about the ACA in an Op-Ed in the Detroit News.

Yesterday, my follow-up story, about the Detroit News allowing Colbeck to go back in and correct some (but not all) of his insanely false factual garbage a solid 10 days later (while failing to give any indication about just how absurdly wrong he had been in the first place) went viral, generating more visitors than any other story I've posted in months.

After an all-day saga, the end result was that the Detroit News finally posted a "correction" notice...except they did so in such a disingenous way (and so long after the original editorial was publshed) as to be nearly meaningless.

After months of never-ending growth, "Healthy Michigan", aka MI's implementation of the Affordable Care Act's Medicaid expansion provision, has officially stabilized at around 600,000 enrollees:

The reason it's bobbling around the 600K mark, of course, is because of normal "churn" as people move onto/off of the program as they gain/lose jobs, move into/out of the state, give birth/lose family members and so forth.

A few weeks ago, the Detroit News posted a story gushing praise all over Michigan's implementation of the Affordable Care Act's Medicaid expansion provision, known locally as "Healthy Michigan", and somehow managed to not mention the ACA once until the 9th paragraph...and even then, failed to explain the connection between the two (as in, HM only exists because of ACA).

A couple of days ago, the editiorial board of the News posted an editorial which correctly calls for the renewal of Healthy Michigan, which requires a federal waiver once a year (I think) in order to continue because it includes modifications from simply increasing the eligibility threshold to 138% of the Federal Poverty Level.

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