Sickly forecast for Healthy Michigan Plan

March 28--TRAVERSE CITY -- Expanded Medicaid cast a safety net under hundreds of thousands of Michiganders, including Katy Bean-Larson and Richard Vegh, but the program's future is uncertain.

Bean-Larson believes that saved her a small fortune in medical bills after she slipped and broke her wrist, while Vegh said he relies on his coverage for bipolar disorder medication.

"Basically I probably wouldn't have been able to afford to keep taking medicine, to keep buying medicine over the counter," Vegh said.

But the Healthy Michigan Plan, Michigan's expanded Medicaid program, is still headed for trouble even after some Washington lawmakers missed their first shot at repealing and replacing the Affordable Care Act.

REPEAL AND REPLACE

The U.S. House of Representatives pulled a bill Friday that would have made fundamental changes to Medicaid, the federal- and state-funded program that covers roughly one in five people nationwide. One change would have cut matching funds the federal government pays to states that expanded Medicaid coverage under the ACA, commonly called "Obamacare."

State law includes a sunset for the Healthy Michigan Plan when the savings associated with the program outstrip the cost to run it. While the state Senate Fiscal Agency had warned the once-proposed reduction would have pushed that up a year, the program could still end after October 2021, unless state lawmakers act.

There are 663,691 Michiganders signed up for the program as of March 20, according to the state Department of Health and Human Services. If lawmakers don't head off the sunset clause and the Senate Fiscal Agency's predictions hold true, Bean-Larson and Vegh could be among the 9,808 Healthy Michigan Plan enrollees in Antrim, Benzie, Grand Traverse, Kalkaska and Leelanau counties to lose coverage.

MIND AND BODY

Bean-Larson, of Kingsley, is self-employed and once volunteered on a Democratic campaign, she said. She dropped previously purchased insurance because the premiums were too steep, even with a subsidy, and went uninsured before that because of high premiums and deductibles.

"I always figured that if I needed to go to the ER, I could pay for that," she said.

Bean-Larson has been covered by the Healthy Michigan Plan for more than a year, she said. She had her first checkup in many years, recently had a mammogram and spoke with a counselor.

Then Bean-Larson slipped on a patch of ice around a week ago and broke her wrist. The former registered nurse went to a clinic instead of the emergency room, but figures the total bill would've still cost a small fortune.

"That would have to come out of a deductible if I had regular insurance, even with a subsidy, and I couldn't pay that out of pocket," she said.

For Vegh, 34, the coverage gives him access to the medicine that's helped him regain control of his bipolar disorder, he said. He lives with family near Traverse City and is studying philosophy and English at Northwestern Michigan College. He signed back up by February after a brief lapse at the end of 2016, and during that gap he paid about $180 a month for his medicine -- a stretch for a college student with two part-time jobs.

Vegh once went several months without medication while living in Hawaii and had a breakdown that ultimately put him on the streets, he said. Now, he's doing well in college and looking to transfer to a university.

BIG DIFFERENCE

Traverse Health Clinic CEO Arlene Brennan said around 1,500 people the clinic serves are covered by the Healthy Michigan Plan, which covers those who don't qualify for standard Medicare or Medicaid but with qualifying incomes.

Michigan's annual income cutoff is 133 percent of the federal poverty level, or $16,000 for a single-person household, according to DHHS information. That's using a person's modified adjusted gross income -- their pre-tax income plus other sources and benefits, but with credits for qualifying expenses.

Expanding coverage made a big difference for those who qualify, giving them access to specialty care along with medicine and primary care, Brennan said.

"So while community health centers, like we are, will help people in financial need, it's sometimes challenging if people don't have health coverage and are very low-income to be able to afford the various components of health care to treat a problem," she said.

FEWER UNPAID BILLS

Hospitals also had to deal with fewer unpaid bills from patients who couldn't afford them after Michigan expanded Medicaid in 2013. Munson Medical Center's uncompensated care costs dropped from more than $22.5 million in the hospital's 2013 budget year to $8.12 million in its 2015 budget year, according to figures from the University of Michigan Institute for Healthcare Policy and Innovation.

Munson Healthcare serves more than 38,000 Healthy Michigan Plan beneficiaries in its 24-county service area. That's according to a letter sent to three U.S. House of Representatives members.

Preventative care also cuts down on future medical costs, said Dianne Michalek, Munson Healthcare director of communications.

"If people aren't seeking preventative care and they don't think that they have coverage, I think it will lead to additional patients in our emergency departments that are waiting until the last minute to seek treatment, because they're afraid they're not going to be able to pay for it," she said.

TIME IS NOW

State Rep. Larry Inman, R-Williamsburg, said state policymakers need to start talking about how to handle more Medicaid costs, rather than wait until the situation becomes a crisis.

The ACA wasn't perfect, and created a market that was harder for working people to buy into while providing health care to the unemployed or those with low incomes for "almost nothing," Inman said.

But no one wants to see a pre-Obamacare situation, where health care is unaffordable for many unless an employer offers it, the uninsured have few other options besides the emergency room and hospitals bear the resulting financial strain, Inman said.

He doesn't think Congress and President Donald Trump will give up on replacing the law, so state lawmakers will have to see what comes of their efforts, he said. Yet it's not too soon for lawmakers in Lansing to start strategizing.

"I think that we have to do a full evaluation of Healthy Michigan, and see if there are more efficient or different ways of providing health care and costs, and get a lot of public input and get a lot of industry input," he said. "We've got to be smart about it, we can't just make judgment calls off the hip, and see what arises out of that discussion and then make a decision."

Healthy Michigan Plan enrollment

As of March 20, 2017

Antrim 1,524

Benzie 1,190

Grand Traverse 4,862

Kalkaska 1,369

Leelanau 863

Statewide: 663,691

Source: Michigan Department of Health and Human Services

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