Back in June, I noted that the Michigan legislature was trying to slap a band-aid on the terrible GOP-passed & signed Medicaid work requirement bill (aka "God's Safety Net" bill) which passed about a year ago.
As you may recall, the original bill added fairly draconian work requirements to Michigan's implementation of the ACA's Medicaid expansion program, known here as "Healthy Michigan". Around 670,000 Michiganders are covered by the program (the number fluctuates between around 650K - 700K from week to week) today.
At the time, several reports had come out putting the number of people likely to lose healthcare coverage under the new requirements (which go into effect on January 1st, 2020) as high as 183,000 statewide, or as much as 28% of the total covered population...thousands of whom would lose coverage even if they do comply with the rules but aren't able to comply with the reporting requirements.
A few weeks ago, I posted a lengthy, in-the-weeds explainer about how the ACA's Medical Loss Ratio (MLR) provision works. The short version is that ever since the ACA went into effect in 2011 (3 years before newly-sold policies had to be ACA compliant), to help reduce price gouging, insurance carriers have been required to spend a minimum of 80% of their premium revenue (85% for the large group market) on actual medical claims.
Put another way, their gross margins are limited to no more than 20% (or 15% in the large group market). Remember, that's their gross margin, not net; all operational expenses must come out of that 20% (15%). The idea is that they should be spending as much of your premium dollars as possible on actual healthcare, as opposed to junkets to Tahiti or marble staircases in the corporate offices, etc. Anything over that 20% (15%) gross margin has to be rebated to the policyholder.
At the time, I concluded that the weighted average change marketwide was a 1.95% reduction in premiums compared to 2019, for around 281,000 Michiganders on the Indy market. This would mean roughly a $10 average premium reduction per unsubsidized enrollee per month, or $116 per year:
Several studies, including this one from just the other day, have driven home this point clearly: Adding work requirements to Medicaid expansion enrollees serves no useful purpose other than to kick tens of thousands of people off of their healthcare coverage (which, of course, is the whole point from the POV of those who add the requirements).
As for the one positive-sounding goal (increasing employment) which supporters always use to try and justify them, that's a complete joke:
The first major study on the nation’s first Medicaid work requirements finds that people fell off of the Medicaid rolls but didn’t seem to find more work.
Last year individual market carriers here in my home state of Michigan only raised premiums 1.7% on average in 2019, with Oscar Insurance Co. being a new addition to the market. For 2020, they're reducing average premiums by about 2.0%. Oscar made very little headway in their debut year, only enrolling 649 people statewide.
On the surface, it looks like Michigan's total ACA-compliant individual market has plummeted by a whopping 18% (281K vs. 344K last year). However, this can be misleading because the enrollment numbers listed each year only include the number of enrollees actually impacted by the rate changes. For instance, if a carrier pulls out of half the state, then a chunk of their current total enrollment won't be listed since enrollees in that half aren't seeing their current premiums change...they'll be losing coverage altogether and will have to switch to a different carrier.
Over the past year or so I've written numerous entries about Michigan Republicans pushing through an ineffective, inefficient, cruel and pointless work requirement addition to Michigan's implementation of Medicaid expansion under the Affordable Care Act, culminating in this one:
New work requirements for people in Michigan's Medicaid expansion group could cause as many as 183,000 people to lose their coverage.
Anywhere between 9 and 27 percent of the approximately 680,000 people enrolled in the Michigan Healthy Plan - or 61,000 to 183,000 recipients - could be kicked of the rolls.
That's up to three times what was estimated by the House Fiscal Agency when the work requirement bill was passed last year. The work requirements are scheduled to take effect on January 1, 2020.
NOTE: Julia A. Pulver, RN, BSN, CCM has been an registered nurse for over 12 years who has spent her career working with the most at risk populations in Southeast Michigan, and is also a personal friend of mine.
UPDATED with my personal initial thoughts (see below):
A few weeks ago I noted that Michigan Republicans were pushing hard for new Democratic Governor Gretchen Whitmer to basically eliminate Michigan's unique unlimited catastrophic care requirement for no-fault auto insurance, which is the main reason our state has the highest auto insurance premiums in the country.
Whitmer and legislative Democrats don't want people to be stuck with massive auto injury medical claims, of course, and they also wanted a guarantee of significant rate reductions as well as the elimination of "redlining" (basing rates on zip codes) and other discriminatory auto insurance pricing practices, like basing premiums on credit ratings, gender and the like.
Over the past year or so I've written numerous entries about Michigan Republicans pushing through an ineffective, inefficient, cruel and pointless work requirement addition to Michigan's implementation of Medicaid expansion under the Affordable Care Act, culminating in this one:
New work requirements for people in Michigan's Medicaid expansion group could cause as many as 183,000 people to lose their coverage.
Anywhere between 9 and 27 percent of the approximately 680,000 people enrolled in the Michigan Healthy Plan - or 61,000 to 183,000 recipients - could be kicked of the rolls.
That's up to three times what was estimated by the House Fiscal Agency when the work requirement bill was passed last year. The work requirements are scheduled to take effect on January 1, 2020.
Michigan is the most expensive state for car insurance for the sixth consecutive year.
The Wolverine State is in a league of its own when it comes to car insurance with an average annual premium that is $313 higher than that of Louisiana, which ranked second. A Michigan car insurance policy averages $2,611, which is almost 80 percent higher than the national average of $1,457.
Louisiana remained in second place for the third year in a row, while Florida secured third place. Oklahoma and Washington D.C. rounded out the top five.
In most cases, a high number of uninsured drivers combined with less than stellar weather and high population density led these states onto the most expensive states for car insurance list.
