The Patient Protection and Affordable Care Act (ACA) will impact every American. How the ACA impacts each state, however, depends largely on funding, and – as always – political will. So, what will happen next in Michigan?

Let’s start with a brief snapshot of health care in the U.S. and Michigan: Over 50 million Americans lack health insurance (about 1.2 million in Michigan), and an estimated 14,000 people in the U.S. lose their health insurance each day.  And in spite of spending over $2.3 trillion dollars on health care each year, high-quality, efficient health care in the U.S. is not guaranteed.

In Michigan, there are three major aspects of the ACA that have yet to be decided:

• Medicaid expansion. The ACA calls for an expansion of Medicaid eligibility from 100% federal poverty level (FPL) to 133%, paid for by the federal government for the first three years, and then costs would shift in small part to the states (10% in 2016). As many as 500,000 Michiganders would gain eligibility. While the Supreme Court ruled that states have the option of whether or not to expand Medicaid at all, and to what extent, it is not clear whether or not Governor Snyder intends to go forward with expansion.
• A statewide health insurance exchange.  For individuals and families within 133–400% FPL, subsidies will be available for them to buy private health insurance in a state health insurance exchange.  Currently, 15 states are well on their way to establishing an exchange. The rest of the states must submit a blueprint for the exchange by November 16, 2012, and receive federal certification by January 1, 2013. Exchanges will be required to go live on October 1, 2013. In Michigan, a Senate bill would pursue a state-run exchange, and Governor Snyder has expressed his support. However, the House has yet to take up the legislation, and time is running out.
• Essential benefits. Essential benefits refer to the services to be covered by every health plan in the insurance exchange. In Michigan, the Office of Financial and Insurance Regulation (OFIR) is responsible for developing the benchmark plan for Essential Health Benefits. A draft plan must be revised and submitted to the U.S. Department of Health and Human Services by September 30, 2012.

While we sit on the edge of our seats to see what the state legislature does—or doesn’t do—next, all agree that it is important for Michiganders to be more educated about what the ACA is, and what it is not.

By Jeri Stroupe