Fantastic! Michigan House Dems introduce bill to make MI the 5th state to launch a Basic Health Plan program!

via the Michigan House Democratic Caucus (this is actually from back in August):

Xiong, Cherry Introduce Medicaid Buy-In Program to Make Healthcare More Affordable for Michigan Workers

LANSING, Mich., Aug. 26, 2026 — State Rep. Mai Xiong (D-Warren) and state Sen. John Cherry (D-Flint) introduced legislation this week to create a Medicaid buy-in program to make affordable healthcare available for more Michiganders. House Bill 6274 and its companion, Senate Bill 1152, would enable Michiganders earning between 138-200% of the federal poverty level to enroll in the program, giving working class families who don’t typically qualify for Medicaid assistance a more cost-effective alternative to other marketplace plans.

“Health premiums are skyrocketing and too often workers on the frontlines of the construction, food service and home care industries are forced to budget out the largest percentage of their paycheck just to keep their families covered,” Xiong said. “Our legislation gives hardworking Michiganders who don’t qualify for public healthcare assistance programs an affordable option. No matter what job or industry someone works in or income level, they deserve access to healthcare.” 

This is fantastic news, sincerely...but before you get too excited, it's important to understand that no, this is technically not a "Medicaid buy-in" program. What it is, instead, is...

Similar Medicaid buy-in legislation, otherwise known as a Basic Health Program (BHP), has been implemented by three other states and Washington, D.C., through the use of federal funding.

“Michiganders are already stretched thin with ever-increasing costs,” Cherry said. “Our constituents should never have to choose between keeping food on the table or seeking care. With the introduction of this legislation, we take an important step toward reducing healthcare costs for those individuals stuck at wit’s end in the marketplace.” 

OK, so what exactly is the difference here? As always, here's my friend Louise Norris with the best explainer of BHP programs:

...Under the ACA (aka Obamacare), states have the option to create a Basic Health Program for people with incomes a little above the upper limit for Medicaid eligibility, and for legal immigrants who aren’t eligible for Medicaid because of the five-year waiting period.

In short, if you earn up to 138% FPL, you enroll in Medicaid; from 138 - 200% FPL, you enroll in a Basic Health Plan policy (BHP); at 200% FPL or higher, you enroll in a Qualified Health Plan policy (QHP).

Federal funding for BHP programs is supposed to be equal to 95% of the total amount of advance premium tax credits (APTC) and cost sharing reduction (CSR) assistance that the enrollees would otherwise have been eligible for had they otherwise enrolled in a QHP using the ACA exchange.

Of course, the state itself can also throw in additional funding to make the BHP plans more generous if they wish...which is a key point to keep in mind. The coverage has to be at least as affordable and at least as good as a benchmark silver plan with Cost-sharing reduction benefits applied.

Unfortunately, one of the casualties of the so-called One Big Beautiful Bill Act (OBBBA) passed by Republicans last year is that legal immigrants not eligible for Medicaid due to the 5-year waiting period are no longer eligible for federal APTC subsidies, which has caused a major blow to the funding of BHP programs...but I believe they're still eligible to enroll in the BHP program if they otherwise qualify:

11. Question: Does H.R.1 have any implications for a state’s Basic Health Program (BHP)?

Answer: While H.R.1 does not directly modify BHP statutory provisions, there are implications for the program because states are provided funding for BHP coverage based on enrollees’ PTC eligibility. In general, the BHP funding formula for states provides a payment of 95% of the value of the PTC and cost-sharing reduction (CSR)[11] for each eligible individual with income up to 200% FPL. As H.R.1 ends PTCs for lawfully present non-citizens with incomes below 100% FPL beginning in 2026, their coverage garners $0 in the state’s BHP payment formula.

However, this group remains statutorily eligible for BHP coverage. Because of the misalignment between CMS reimbursement and the coverage requirement, in December 2025, CMS announced that BHP states can discontinue coverage for this group without penalty. Specifically, CMS said it would exercise enforcement discretion for three years (January 1, 2026 through December 31, 2028) and not take action against a state that chooses not to provide BHP coverage to lawfully present non-citizens with income below 100% FPL.[13] CMS has not indicated whether it will permit a similar coverage exception beginning in 2027 for lawfully present non-citizens with income between 100% and 200% FPL who are no longer eligible for PTC but are still statutorily eligible for BHP.

In any event, BHP programs provide very low-cost, comprehensive healthcare coverage for around 1.5 million Americans across New York, Minnesota, Oregon and the District of Columbia. Michigan joining this list would be very helpful to perhaps ~240,000 low-income Michiganders (nearly half the ACA enrollment population, in fact), plus an unknown number of additional currently uninsured residents.

Of course there's zero chance of this program passing until next year at the earliest, assuming Democrats are able to achieve a trifecta in the state government. Stay tuned...