Friday, August 9, 2013


On October 1st, 2013 open enrolment begins in the Marketplace, the on-line mall where eligible people (those with incomes between 133% and 400% of the Federal poverty level) will be able to buy health insurance under the Affordable Care Act. In many states, October 1st is also the day when open enrolment begins for people newly eligible for Medicaid. What we are hearing is that Michigan is likely to be one of those states, as it is increasingly likely that in late August the legislature will accept Federal funding to make Medicaid available to all citizens with incomes below 133% of the Federal poverty level.

This is a really great thing, because as many as a million Michiganders (maybe 15,000 in Mid-Michigan) who have been suffering without health insurance could finally be covered. More benefit will result from the expansion of health care coverage than many of us understand. First, the newly insured people will have access to preventive health services which will reduce premature death and disability. This will improve the overall health of our communities. Second, covering these people will reduce the cost of health care for people who already have insurance.  Why? Because the emergency room and other uncompensated health care costs of the uninsured show up in the medical bills of those with insurance and these will start to go away. Third, falling health care costs will benefit employers by reducing the costs of their employees’ benefit packages. This will help the whole economy.  Are you skeptical of these claims?  Keep reading because down below I’ll look at the experiences of the states that have already implemented the Marketplace.

Before I go there I have to acknowledge that many, many people are confused about the whole Obamacare thing. In reality, there are only two things you need to know about October 1st: 1) If you want Medicaid you can go to the MiBridges website and find out if you are eligible and sign up if you are. 2) If you want to shop on the Marketplace you can go to the Marketplace website (it’s not up yet) and find out if you are eligible and get health insurance there. And if you use the Marketplace you may qualify for a generous subsidy to help you make that purchase depending on your income. That’s it! You are now fully informed! All the rest of what you have been hearing is overheated political hype.

The graphic above helped me understand how simple it is. The Medicaid expansion will cover low income adults with incomes up to 133% of the Federal poverty level, or kids up to 200%. The rest of us with incomes up to 400% of the poverty level will be eligible to get a subsidy to get insurance on the Marketplace (when this chart was made it was called the Exchange).

But what about the whole “mandate” thing? Yes, it’s true that if you are eligible for the Marketplace, but choose not to buy health insurance, and if you owe taxes, then you will have to pay a little bit more in taxes ($90). They’ll use those tax dollars to pay hospitals to take care of the uninsured. That’s the big, bad mandate.

The challenge for local public health—indeed for the entire health and health care community—is that research indicates that as many as three-quarters of those who will be eligible for health insurance don’t know it!  Somehow we need to get the word out. And if we are successful, and folks want to sign up, we have to be ready to help them do it.  Making this much more difficult is the fact that the Michigan Legislature refused Federal assistance with the Marketplace. The State could have received $30 million to plan for open enrolment, but it declined. Because of this public agencies and non-profits across the State are being asked to do the work of preparing for open enrolment without funding.
Nonetheless, community agencies are trying to figure out how to respond. Michigan Consumers for Healthcare has helped pull together regional meetings to orient people to the Affordable Care Act.  You should visit their website if you’ve got questions about it.  And in each of our counties we are convening the community collaboratives to plan as best we can for open enrolment.  The Building Stronger Communities Council in Clinton, The Gratiot Collaborative Council and the Montcalm Human Services Coalition have all come together to create plans to publicize open enrolment and to tell community members where they can go to get help signing up for health care coverage.

OK, I promised to share some of the evidence about the benefits of the implementation of the Marketplace.  I’ll skip recent articles crowing about 30-50% reductions in premiums for individual plans in Oregon and New York.  It’s likely other plans and other states won’t see results that good.  Instead let me refer you to a more balanced article that gives a good overall analysis. In the article, Economist David M. Cutler concludes that growth in health care costs is slowing down as a result of the Affordable Care Act and that the economy will certainly benefit.  Indeed he says…

“Neither the sequester nor the Medicare tax increase in the Affordable Care Act would have been necessary if Washington had dealt with health spending some time back.”

As a final treat here is a link to a cute six minute video that shows how the whole plan is supposed to work.  Enjoy.