CHRT Projects Regional Impact of ACA, Medicaid Expansion Across Michigan

The Center for Healthcare Research & Transformation (CHRT), based at the University of Michigan, issued projections on the likely coverage effects of the Affordable Care Act (ACA) in Michigan – both with and without an expansion of the Medicaid program. The projections focus on the adult population, aged 19-64, that will be eligible for Medicaid if the state approves its expansion and adults that will be eligible for tax credits to subsidize private coverage via the health insurance exchange.

“While there will be many people in Michigan who will be able to choose health plans through the new insurance exchanges starting this fall, most will continue to get their coverage through their employers or through Medicare or Medicaid,” says Marianne Udow-Phillips, director of CHRT. “If the state does expand  Medicaid, we estimate that approximately 127,000 people will enroll in health plans through the new insurance exchange and, 320,000 additional people in Michigan will become covered by Medicaid.”

CHRT’s research describes the expected characteristics of those who are eligible to get coverage in Michigan as a result of the ACA, including geographic distribution, current coverage, age, gender, employment, education and race/ethnicity.

“Our research shows that access to affordable health coverage is a statewide issue. After Wayne County, four of the five top regions in the state that had the highest rates of uninsurance in 2011 were rural counties in the northern Lower Peninsula and the eastern Upper Peninsula. ”

CHRT’s research and projections show that:

1)  More than one in six Michigan adults was uninsured in 2011. Michigan had 1.1 million uninsured adults in 2011 aged 19-64. Access to coverage varies by region and income level. Wayne County, including Detroit, plus rural regions in northern Lower Michigan and the Upper Peninsula had an uninsured rate of 20 percent or greater. Washtenaw County at 11 percent had the lowest rate of uninsured.

2)  With Medicaid expansion, 93 percent of Michigan’s uninsured would have an affordable coverage option by 2019 via either Medicaid or exchange-based tax credits. By 2019, the uninsured rate in Michigan could be expected to drop from its current rate of 13.6 percent to 6 percent.

3)  Without Medicaid expansion, 40 percent of the state’s 1.1 million uninsured would be left without an affordable coverage option, including those below 100 percent of the federal poverty level. With the simplification of the Medicaid enrollment process under the ACA – but without expansion – Medicaid enrollment by adults and children could be expected to increase gradually by 60,000 by 2019. Without expansion, in 2019, the uninsured rate in Michigan could expect to still be 10 percent (830,000 non-elderly adults).

4)  Under the ACA without Medicaid expansion, the percentage of the uninsured that will be eligible for tax credits varies by region from a high of 59.4 percent in Midland and Bay Counties to a low of 36.5 percent in Wayne County including Detroit. Those below 100 percent of the federal poverty level, the poorest of the poor, would not be eligible for a tax credit whether or not Michigan decides to expand Medicaid.

5) Employer-sponsored health coverage will continue to be the dominant source of coverage in the state whether or not Michigan decides to expand Medicaid.

CHRT is issuing three research briefs as part of its Cover Michigan Survey 2013 series: “The ACA’s Coverage Expansion in Michigan: Demographic Characteristics and Coverage Projections”, “Regional Variation of the ACA’s Coverage of the Uninsured in Michigan”, and “The Uninsured in Michigan.” Copies of the briefs are available at www.chrt.org.

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