Health plans fill ACA holes

Voters are being asked Tuesday to vote for a millage to support the Ingham County Health Plan, which provides health coverage for low-income residents.

Why do we need it? Doesn’t the Affordable Care Act cover everyone?

No, says Ingham Health Plan Executive Director Robin Reynolds, who provided these answers.

The ACA safety net doesn’t catch everyone and if the county doesn’t continue to fund the health plan, people will either go without coverage or they will use the emergency room and pass the costs on to the public at a much higher rate.

We asked Reynolds about the need for the millage and what it would cost and who it serves.

How much would be raised?

Voters will be asked to renew a 0.52 mill tax, which could potentially bring in more than $3.4 million in the first year. It would cost the owner of a house with a $100,000 taxable value $52 a year.

What is the Health Plan?

The Ingham Health Plan provides coverage for doctors visits and some health ser vices for low-income residents. The program had approximately 10,000 people enrolled prior to Healthy Michigan and the Affordable Care Act opened enrollment earlier this year. Currently we have 814 enrollees and we’re getting about 100 a month back onto the plan.

Who does it cover?

It is serving people who are at $28,000 a year or below (about 250 percent of poverty) and it is covering people who don’t have any other insurance and live in Ingham County.

What amount is considered poverty?

Poverty is $11,670 a year for a single person.

What is Healthy Michigan? Healthy MIchigan is the new enhanced state Medicaid plan. It is open to any individual earning under 138 percent of poverty ($16,105 for a single person). That was a lot of the people we covered in the past.

What does the Affordable Care Act cover?

Affordable Care Act is zero to 400 percent of poverty or $46,680 a year. Those eligible purchase a product and get some federal subsidy.

Out of all the people that are covered there are holes.

The exchange is expensive and the deductible is expensive. If your medical expenses are above 8 percent of your annual income you can apply for a hardship waiver. So what’s on the exchange is still deemed unaffordable for some.

Hardship waivers can be issued if you’ve claimed bankruptcy, if you’ve been evicted or had utilities shut off.

They can then come on the Ingham Health Plan.

We estimate 30 percent of those eligible for the Affordable Care Act in Ingham County may need to apply for a hardship waiver. That’s about 3,200 people.

Who else does the Ingham Health Plan cover?

People who are noncitizens aren’t eligible for Medicaid or the Affordable Care Act. They have to have been in the country for five years. Some are undocumented immigrants. Whether we dispute whether they should be here or not, we offer our community benefit to them so they don’t go to hospital for basic care.

Another group we cover we call “the churn.” They go off Medicaid when they make $3 more than allowed. We cover them while they’re waiting to get on a plan. Sometimes it takes a couple of months. We’ll provide 90 days of coverage to keep medications filled and basic health services covered.

And lastly another huge group has to do with a glitch in the ACA. It’s called the family glitch. If you’re with an employer and the employer offers insurance to the employee that it deems affordable he cannot go on the exchange and get coverage. But if he adds his wife or kids to the work policy it becomes unaffordable. He can afford it but he can’t afford (the higher cost for) his family. So there could be potential families where the employee has employer coverage but the family doesn’t.

What are other counties doing?

There were county health plans in most counties. A lot are smaller. Most don’t have millages. There are about five health plans that will continue to operate: Kent, Washtenaw, Genesee, McComb and Muskegon counties. All those will continue but a lot of them are going away because they don’t have a revenue source.

Ingham and Genesee are the only counties that have a millage.

Don’t hospitals pay for indigent care already? Why should the county do it?

The millage was only a piece of what we had. We had $8 million coming from the hospital. Federal dollars used for uncompensated care from Disproportionate Share Hospital Funds. This is money that the state and feds give hospitals to match for their uncompensated care. Hospitals have funded us to try to alleviate that care rather than have people go to the hospita. DSH ends Dec. 30 as part of the ACA. That money will be reduced over the years because hospitals will have less uncompensated care because of the Affordable Care Act.

Why should Ingham taxpayers support this?

Our goal is that we’ll have 100 percent coverage of some type ... Keeping people healthy is a priority. It does give back to the community. And if we don’t pay for them here we’ll pay for them in the ER or inpatient care and that will be a lot more. Somebody will pay for it. That’s you and me through our health plans. We’ll pay for it through our insurance benefits. We’d rather pay for it while it’s low cost.