Now that the Affordable Care Act will remain the law of the land, Dominick Pallone would like to see Congress and President Trump work to improve the federal health reform law.
The failure of the proposed American Health Care Act to gain enough support in the GOP-controlled Congress “is a good thing,” said Pallone, executive director of the Lansing-based Michigan Association of Health Plans that represents 14 commercial and Medicaid health insurance companies across the state that collectively cover 2.5 million people.
“We’ve been telling our congressional delegation to take time and slow down and better understand the implications of any legislative reform on Michigan,” Pallone said. “There are some clear concerns that we have.”
Those concerns focused on implications for Medicaid and provisions in the proposed law that would have repealed expansion of the state-federal program. Instead, the GOP bill would have provided states with per-capita grants and allowed them to cap spending. The provisions would have effectively ended traditional Medicaid and the Healthy Michigan Plan, the state’s version of Medicaid expansion under the ACA.
The Michigan Health & Hospital Association opposed the ACHA as well, citing the impact on Medicaid and the potential for a “severe and negative impact on Michigan residents, our communities and our hospitals and health care networks.”
“Our association, comprised of hospitals and health systems throughout the state, has seen ACA-related programs like the Healthy Michigan Plan make a meaningful difference in the health of adults throughout the state. We need to protect that coverage for every Michigan resident who relies on it for their care and well-being,” association CEO Brian Peters said in a statement. “We will continue to work diligently with our elected officials and urge them to take a thoughtful, responsible approach to fixing the Affordable Care Act, rather than one that may dismantle coverage for many of our most vulnerable neighbors.”
About 1.8 million people in Michigan were enrolled in traditional Medicaid at the end of 2016, and another 649,000 were covered under the Healthy Michigan Plan. Under a provision in the now-dead ACHA, “Michigan and most states would be likely to stop covering the expansion population over time,” according to an analysis by the Ann Arbor-based Center for Healthcare Research and Transformation (CHRT).
The GOP proposal also would have eliminated federal subsidies to help people at 250 percent of the poverty level or below to buy health coverage on a public health exchange. About 165,000 Michigan residents, or 52.6 percent of the people who bought coverage on the public exchange, qualified for assistance in 2016, according to the CHRT analysis. Another 275,000 Michigan residents bought individual coverage using federal tax credits available under the ACA.
The ACHA also would have based tax credits on age, rather than on income as they are now.
Although U.S. House Speaker Paul Ryan said Friday that Republicans will move on to other issues such as tax reform, Pallone would like to see Congress stay at it and work to improve the ACA.
“I’m sure this isn’t the end of health care reform or the end of the conversation at all,” Pallone said. “This issue, I’m sure, is not over.”
The Michigan Association of Health Plans favors changing an area of the ACA that caps the highest premiums charged within a covered group of people to no more than three times the lowest premiums.
Allowing states to move from a three-to-one to a five-to-one ratio, based on what works best for their market, could push down premiums on the low end, Pallone said. That may result in more affordable premiums and entice younger, healthier people to buy coverage and improve the insured risk pool, potentially making rates on the top end more affordable, he said.
The association also backs changing the ACA to ease coverage mandates and give health insurers and health plans greater flexibility to craft lower-cost benefits packages, ranging from “simple” plans with just catastrophic medical coverage to so-called “Cadillac” plans.
“Our members very much want to bring new, innovative products to the market and let the market work. If there’s demand for a product, let’s meet that demand,” Pallone said. “We want to sell products that people want to buy, not what they are mandated to buy.”
Mercy Health in West Michigan, with Mercy Hospital in Muskegon and Mercy Health Saint Mary’s Hospital in Grand Rapids, also opposed the ACHA. Mercy Health cited as its reasons the Medicaid provision, the 24 million who could have lost coverage over five years, and “inadequate coverage for those who remain covered” with the elimination of the minimum essential benefits mandate in the ACA.
Mercy Health is owned by Livonia-based Trinity Health, one of the largest Catholic health systems in the U.S.
“As always, Mercy Health Saint Mary’s and Trinity Health remain open to exploring flexible, alternative approaches to providing access to coverage and care for all in the United States,” according to a statement from Mercy Health issued prior to last Friday’s demise of the ACHA. “We are hopeful that there are bipartisan, public-private solutions that help our nation move forward in caring for everyone.”