Health Care Reform: Potential Effects on MI
U.S. Senators are having daily meetings on health care legislation, in addition to a small, informal work group. The works continues as the Senate awaits the release of the nonpartisan Congressional Budget Office's (CBO) analysis of the House’s recently passed bill. The CBO report may be released within the next week.
There’s a lot on the table as lawmakers and organizations across the country work to determine how the Affordable Care Act (ACA) and the House’s plan to repeal and replace it, the American Health Care Act (AHCA), compare and what they mean for our communities.
There are potential changes that could affect everyone, not just those who purchase health care coverage through the marketplace, or receive health care through the Medicaid expansion but also those who receive health care through an employer-provided plan.
The Economic Impact
Our country’s unemployment rate is at 4.4 percent, the lowest rate in more than a decade and experts say the health care industry is a catalyst for that growth.
The New York Times reports that the “health care industry has been an engine for much of that hiring, adding jobs at more than three times the rate of the rest of the economy since 2007.”
The Times cited economists who say the expansion of Medicaid has helped lead to a growing health care sector, an expansion which is made possible under the current ACA.
As CMF has reported, the Healthy Michigan plan, which is available through Medicaid expansion under the ACA, provides health care coverage to about 649,000 low-income individuals between the ages of 19 and 64 in Michigan.
The Center for Healthcare Research and Transformation (CHRT), a nonprofit and nonpartisan impact organization, joined CMF members at an InFocus Southeast Michigan event last week, to provide a briefing on the economic and health care impact of the Medicaid expansion and an analysis of the health care reform that’s in the works.
CHRT’s research shows Medicaid expansion has:
Impacted Michigan’s economy by generating 30,000 new jobs annually
Added $2.3 billion in additional spending power
Added economic activity that generates $150 million in state tax revenue annually. CHRT says this revenue offset nearly all of the state’s share of Medicaid expansion costs in 2017.
Led to a 45 percent reduction in the uninsured rate in Medicaid expansion states, which includes Michigan through the Healthy Michigan plan.
Led to 90 percent of hospitals seeing reductions in uncompensated care in Michigan in 2015
ACA vs ACHA
As the Senate prepares to examine the ACHA, CHRT shared the latest May update on key provisions from the AHCA and who may be affected by the changes.
Highlights of CRHT's issue paper include:
Under the current ACA: There are about 1.8 million “traditional” Medicaid enrollees and 649,000 Healthy Michigan Plan enrollees, all covered under Medicaid.
What it would look like under the ACHA: It freezes Medicaid expansion in 2020. For those who aren't enrolled before the end of 2019, or lapse coverage for more than a month, the state would only receive 65.1 percent federal matching rate, creating a higher burden on the state to carry the unfunded costs. That means for those who lapse coverage for more than a month, it will reduce the number of people who qualify for full funding but their health care needs will continue. As a result, CHRT says Michigan and other states would likely stop covering the expansion population over time due to cost.
Shift Medicaid from funding based on the cost of coverage to block grant
Under the current ACA: In 2015, Michigan Medicaid cost $15.9 billion, the federal government covered $11.6 billion.
What it would look like under the ACHA: Starting in 2020, the rates of increase in federal funding would be limited to medical inflation and enrollment but won’t consider technology changes or intervention enhancements, which would transfer considerable costs to states over time.
Change tax credits
Under the current ACA: Tax credits are based on incomes and premium costs.
What it would look like under the ACHA: Tax credits would be based on age and allow tax credits to be used on or off the exchange. This would make AHCA tax credits 13 percent lower than the average tax credits under the current ACA.
Repeal cost-sharing reduction subsidies:
Under the current ACA: The ACA includes cost sharing subsidies for those at 250 percent of the federal poverty level or less. In 2016, nearly 53 percent of those enrolled in the exchange received cost-sharing subsidies through the ACA.
What it would look like under the ACHA: The ACHA would repeal these subsidies in 2020.
Individuals with a lapse in coverage:
Under the current ACA: Those who lapsed in coverage longer than three months paid $695 or 2.5 percent of their income.
What it would look like under the ACHA: Those with a lapse in coverage longer than 63 days would pay 30 percent higher premiums for one year once they re-enroll.
Essential health benefits:
Under the current ACA: There are federal standards that determine essential health benefits (EHB). These benefits include ambulance, laboratory, pediatric and emergency services, hospitalization, maternity and newborn care, preventative care, rehabilitation services and mental health care.
What it would look like under the ACHA: States would be able to apply for a waiver and determine essential health benefits or underwrite financial assistance for those who are considered high-risk. This could affect everyone, even those who receive health care through an employer-provided plan.
Read CRHT’s issue paper on the key provisions.
Connect with CMF’s Health Funders Affinity Group.
Learn more about the Healthy Michigan plan.
Food Deserts in MI
Michigan’s urban and rural areas are home to “food deserts,” areas that lack adequate access to grocery stores. The USDA estimates about 1.8 million Michiganders lack adequate access to healthy food.
“We have a lot of places, especially in dense areas, where they don’t have small grocery stores,” Rep. Andy Schor said. “We’re seeing a lack of those in our cities and people want walkability when they move to these areas.”
The USDA’s Food Access Research Atlas illustrates how our food deserts are in both urban and rural areas statewide. If you check out the atlas, you can see an overview of low-income areas and those that lack access to grocery stores from numerous cities including Detroit, Flint, Grand Rapids and Muskegon, to rural areas in Northern Michigan and much of the Upper Peninsula.
There’s legislation pending in the Michigan House that would address the issue by setting aside funding from the Michigan Strategic Fund’s Michigan Community Revitalization Program to support projects that would create new grocery stores in underserved, low-income or blighted urban areas.
House Bill 4207 is aimed at providing access to food, incentivizing grocery stores to locate in urban areas, encouraging investments, creating new jobs and transforming property that otherwise wouldn’t be revitalized.
The Detroit Free Press reports that under the bill “at least 5 percent of the community revitalization money would go to neighborhood food incentives, which could include low-interest loans, grants or other assistance.”
If passed, this bill could provide greater opportunities for community revitalization and public-private partnerships.
From the U.P. to the lower mitten, CMF members are working statewide to increase access to healthy food for Michigan families.
A few examples of food access initiatives already at work in Michigan include:
The Flint Fresh Mobile Market, supported by three CMF members, is taking healthy food directly to underserved neighborhoods. Through Flint Fresh, residents can also order veggie boxes to be delivered to their homes.
In Detroit, Eastern Market recently announced a new partnership with Michigan Farm to Freezer, that takes produce and “flash-freezes it to preserve nutrients and flavors and packages it for purchase by schools, grocery stores” and more.
The Michigan Good Food Fund, supported by several CMF members, is an impact investing fund that provides financing to food businesses to increase access in underserved areas.
As we follow the legislation that’s in the works in the House, CMF and the Office of Foundation Liaison (OFL) are looking for opportunities for funders to get involved in this area and further address food access issues.
Questions? Please contact Karen Aldridge-Eason or Stephen Arellano from OFL.
Check out the USDA’s Food Access Research Atlas.
Stay updated on House Bill 4207 and track its progress here.
Sign the Michigan Healthy Food Access Campaign’s petition supporting legislation to boost food access.
Creating a Path to Success for All
Michigan’s recent jobless report shows unemployment rates dropped statewide, with 17,000 people gaining jobs, but as research and our governor point out, it’s not enough to put Michigan on a path to success.
“While these latest numbers are certainly promising, we must not become complacent,” Governor Rick Snyder said. “Since 2010, more than half-a-million private-sector jobs have been created and more are on the way. Now we need to make sure Michiganders have access to the education and training necessary to work in the high-demand, high-wage careers now available.”
A new report shared by Michigan Future echoes the governor’s sentiments. While good news, it’s not enough to have a low employment rate or growing businesses, the report calls for policies that support elevating household incomes for all.
This comes following a report CMF shared last month that demonstrated growing disparities in our state, as 40 percent of Michigan households still can’t afford the basics.
In Michigan Future’s first ever policy agenda, supported by several CMF members, A Path to Good Paying Careers for All Michiganders: A 21st Century State Policy Agenda, provides a framework that aims to move Michigan forward, supporting policy and initiatives that ensure a shared prosperity for all Michiganders.
The report highlights several issues at play:
We need higher paying jobs. Michigan is 16 percent below the national average in wages and benefits per capita. In 2000 Michigan was one percent below the national average.
We need shared prosperity. Michigan economy is growing and only “the top is benefitting from the growth,” leading to a growing middle-class gap.
We need to increase education attainment and outcomes. Michigan ranks 32nd in the proportion of adults with four-year degrees or more and our state has low student outcomes in K-12 education.
We need to be ready to adapt to a changing workforce. Our future workforce may require a more comprehensive skillset for Michigan workers as computers and automated machines may fill some roles.
The report outlines several policies and strategies our state could leverage to address these areas and aim for a shared prosperity, increasing household income levels for all.
Increase education attainment and outcomes
Enhance standards, support equitable funding and raise the bar on accountability.
Ensure children of all socio-economic levels receive a high-quality and well-rounded education. Support incentives and policies to integrate neighborhood by race and income levels.
Provide students with a lifelong skillset that can develop human capital and can’t be replaced by machines including collaboration, communication, content, critical thinking, creativity and confidence which helps us take risks.
Increase our labor force and increase returns for working to share prosperity
This could be done by providing benefits and services to those who aren’t working or have low-wage jobs and break down barriers to employment that may include child care, transportation, housing, substance abuse support, financial education and more.
Create places where mobile talent wants to work and live
Attract and retain college-educated Millennials.
A concentrated talent pool attracts higher paying jobs and are more likely places where startups form.
The report stresses the importance of supporting Michigan’s diverse community landscape that encompasses rural and urban areas, by ensuring they have the resources to develop their own strategies to create a place that attracts and retains talent and suits their specific community.
There are placemaking strategies that can be leveraged in urban and rural areas, including creating policies that ensure the community is welcoming to all and increased public investment in quality infrastructure and basic services.
The report shares that its recommendations will carry a price tag and one option may be to raise taxes at some point, but Michigan Future is open to all ideas to fund these recommendations and create a path to a stronger, better prepared workforce and a shared prosperity that works for all Michiganders.
Read the full report, A Path to Good Paying Careers for All Michiganders: A 21st Century State Policy Agenda.
5 Healthy Towns Foundation’s work spotlighted in 2017 Active Community Award
Content excerpted and adapted from MLive. Read the full article.
Grass Lake Charter Township and the Village of Grass Lake were honored with the 2017 Governor’s Active Community Award.
MLive reports that the Active Community Award honors “communities that work to create a healthy environment through increasing opportunities for physical activity and creating policies to promote it.”
The township credits the award to the work and financial support of the 5 Healthy Towns Foundation (5HF), a wellness-focused foundation aimed at helping the communities of Grass Lake, Chelsea, Dexter, Manchester and Stockbridge through the expansion of wellness-related programs, policies and infrastructure.
Within the last four years, Grass Lake has implemented 27 wellness programs thanks in part to the support and grants from 5HF.
Since 2011, the Grass Lake Community Wellness Initiative (GLCWI), created in partnership with the foundation, has been working on addressing prescription and opiate drug abuse in the community and helping its residents live healthier lives.
5HF is focused on encouraging people in the five towns to eat healthier, be more active, avoid unhealthy substances and connect with others in healthy ways.