Michigan

Michigan is the 8th state (by my count) where the insurance carriers have posted their preliminary 2021 premium rate change filings. Every year brings some new twist (in 2018 it was CSR reimbursement payments being cut off; in 2019 it was the zeroing out of the ACA's federal individual mandate penalty; in 2020 it was sort of the repeal of the ACA's health insurer tax (HIT), although that didn't actually happen until after 2020 premiums had already been locked in; and for 2021...it's the COVID-19 pandemic, of course.

I've therefore added a new column for my weighted average rate change spreadsheets. So far only a handful of carriers have tacked on any substantial rate changes due to expected cost increases from testing & treatment of COVID-19 next year...the general rule of thumb seems to be that the added costs are pretty much gonna be cancelled out by reduced claims from non-COVID healthcare services (delayed/cancelled treatments/procedures, etc).

As a follow-up to my prior posts about the urban/rural divide of how COVID-19 has spread throughout Michigan, here's a graph which shows how it's spread in Detroit, the larger Metro Detroit area and the rest of the state on a per capita basis over time.

Obviously the probem is still far worse in Detroit and the Metro Detroit area overall...but the case trendlines are starting to flatten in Detroit and Metro Detroit, while it's still increasing at the same rate or higher in the rest of the state.

A few weeks ago, I posted a detailed analysis of how the COVID-19 virus has been spreading throughout my home state of Michigan. I noted that while the outbreak originally spread quickly in Detroit and the more densely-populated Metropolitan Detroit region (Wayne, Oakland and Macomb counties), that has gradually changed over time, with the virus spreading to the rest of the state--including rural, conservative-leaning areas--at a faster rate while it slowed down in the urban areas.

It's time to check in to see whether that trend has continued...and sure enough, it has:

For the past month, I've spent an awful lot of time tracking COVID-19 cases and fatalities on a state-by-state level. I'm obviously not the only one doing this; there's literally dozens of other much more respected and capable organizations and websites doing so, and in fact my data originally comes from several of those sources (primarily Worldometers and the COVID Tracking Project).

I have, however, included a few extra data points which some sites haven't in order to add some perspective:

via a press release from the Michigan Dept. of Insurance & Financial Services:

The Michigan Department of Insurance and Financial Services (DIFS) announced that the state has received agreements from nearly all of the state’s health insurance companies to waive cost-sharing, including copays, deductibles, and coinsurance for coronavirus (COVID-19) testing and treatments. The Whitmer Administration and DIFS had worked with insurers to waive these costs.

“Michiganders that are fighting for their lives should not have the extra burden of fighting with their health insurer to cover the costs of their care,” said Governor Gretchen Whitmer. “I am thankful that health insurers agreed to cover Michiganders’ coinsurance, deductibles, and copays as we fight this virus. It’s going to take all of us doing our part to slow the spread of COVID-19. We will get through this together” 

Consumers with these individual and group health plans will not be charged cost-sharing for coronavirus-related medical treatment, such as primary care visits, laboratory testing, emergency room visits, ambulance services, and FDA-approved medications and vaccines for COVID-19 when they become available. 

via a bulletin from Michgan's State Emergency Operations Center:

Healthcare Coverage Available to Michiganders who Lose Job or Experience a Drop in Income

LANSING, MICH. Michiganders who lose a job, resulting in a loss of their healthcare coverage or a change in income, may have low or no-cost healthcare options available through the Affordable Care Act (ACA) Marketplace, Medicaid, or the Children’s Health Insurance Program (CHIP).  Consumers in these situations are not required to wait for the yearly Open Enrollment Period and should act now.

“Michiganders who lose employer-based health insurance may have options to continue or replace their coverage,” said DIFS Director Anita G. Fox. “If consumers have questions about enrolling, DIFS is available to assist.”

The following memo has been floating around Twitter since last night. I was concerned that it might be a hoax, but this response Tweet from the official Henry Ford Health System account can only be interpreted as confirming that it's very real...just not public as of yet. It appears to be a legitimate internal policy memo being prepared in the event of a worst-case scenario:

With a pandemic, we must be prepared for worst case. With collective wisdom from our industry, we crafted a policy to provide guidance for making difficult patient care decisions. We hope never to have to apply them. We will always utilize every resource to care for our patients.

— Henry Ford News (@HenryFordNews) March 27, 2020

@charles_gaba retweet this, your national audience needs to see this

Michigan:

Governor Whitmer Announces Statewide Closure of All K-12 School Buildings; School building closures will last Monday, March 16 through Sunday, April 5

Today, Governor Gretchen Whitmer announced that in order to slow the spread of Novel Coronavirus (COVID-19) in Michigan, she is ordering the closure of all K-12 school buildings, public, private, and boarding, to students starting Monday, March 16 until Sunday, April 5. School buildings are scheduled to reopen on Monday, April 6. 

As of tonight, the number of presumptive positive cases of COVID-19 in Michigan is 12. 

I'm sure you've noticed that I've been posting more frequently about Michigan re. COVID-19 stuff than other states; there's a simple reason--my family and I live here. I'll still be posting major breaking developments for other states as well, of course, but I'm understandably more attuned to what's going on in my own state...

via Michigan Governor Gretchen Whitmer's office:

Whitmer Administration Expands Telemedicine, Urges President Trump to Permit ACA Special Enrollment Period During COVID-19

Well, this was inevitable:

Michigan announces first presumptive positive cases of COVID-19

Governor Whitmer declares a state of emergency to maximize efforts to slow the spread

LANSING, Mich. – Gov. Gretchen Whitmer, the Michigan Department of Health and Human Services (MDHHS) and the Oakland County Health Division and Wayne County Health Department announced today that two Michigan residents tested presumptive positive for coronavirus disease 2019 (COVID-19), the first confirmed cases in the state. The governor has declared a state of emergency to maximize efforts and assist local governments and officials to slow the spread of the virus.

"We are taking every step we can to mitigate the spread of the virus and keep Michiganders safe," said Governor Whitmer. "I have declared a state of emergency to harness all of our resources across state government to slow the spread of the virus and protect families. It’s crucial that all Michiganders continue to take preventative measures to lower their risk, and to share this information with their friends, family, and co-workers."

via David Eggert:

LANSING, Mich. (AP) — Michigan health insurers said Friday they will cover the cost of medically necessary tests for the new coronavirus for people covered under employer and individual health plans, while Gov. Gretchen Whitmer announced the waiving of testing and treatment fees for Medicaid recipients.

...Plans that will waive copays and deductibles for testing costs include Blue Cross Blue Shield of Michigan, Blue Care Network, Priority Health, CVS Health, McLaren and Meridian, according to the governor’s office. The change will not apply — for now — to large employers that self-insure but use insurance companies to administer their benefits.

...Blue Cross Blue Shield will forgo prior authorization rules for diagnostic tests and covered services to treat the disease, set aside refill limits on prescriptions, and expand access to telehealth and a 24-hour nurse hotline.

OK, this is actually from two days ago but it's been kind of a busy news cycle...

Governor Whitmer Creates Task Forces to Combat Spread of Coronavirus

March 3, 2020 

Governor creates COVID-19 task forces focused on state operations, health care, education, and the workforce 

 LANSING, Mich. -- Today, Governor Gretchen Whitmer announced the creation of four task forces to combat the spread of coronavirus and assess the impact it may have on Michiganders’ day-to-day lives. The task forces include: 

This just broke moments ago so I don't have much in the way of details yet:

DC district court just entered summary judgment holding Michigan’s Medicaid work requirements are unlawful.

— Jane Perkins (@perkins_nhelp) March 4, 2020

Work requirements are a policy disaster -- and their suspension by court order here in Michigan is an extraordinarily positive development.

— Nicholas Bagley (@nicholas_bagley) March 4, 2020

There is, however, also this:

Last March I wrote an analysis of H.R.1868, the House Democrats bill that comprises the core of the larger H.R.1884 "ACA 2.0" bill. H.R.1884 includes a suite of about a dozen provisions to protect, repair and strengthen the ACA, but the House Dems also broke the larger piece of legislation down into a dozen smaller bills as well.

Some of these "mini-ACA 2.0" bills only make minor improvements to the law, or make improvements in ways which are important but would take a few years to see obvious results. Others, however, make huge improvements and would be immediately obvious, and of those, the single most dramatic and important one is H.R.1868.

The official title is the "Health Care Affordability Act of 2019", but I just call both it and H.R.1884 (the "Protecting Pre-Existing Conditions and Making Health Care More Affordable Act of 2019") by the much simpler and more accurate moniker "ACA 2.0".

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