2017-05-18 / News

MLPP: Health bill would hit rural areas hard

LANSING – The U.S. House Republican health bill would be particularly harmful to Michigan’s rural communities, according to a new report released by the Washington, DC-based Center on Budget and Policy Priorities. With debate now underway in the Senate, Senators Debbie Stabenow and Gary Peters–longstanding champions for affordable healthcare – can work with their colleagues to prevent the bill’s harmful cuts and other changes from ultimately becoming law. The Michigan League for Public Policy strongly opposed the American Health Care Act and continues to work with state and national partners to advocate for the protection of the Affordable Care Act and the Healthy Michigan Plan and the affordable, quality healthcare they provide for millions of state residents.

“Despite the economic and health struggles of our state’s rural residents, nearly all of Michigan’s congressional delegation that represents rural communities surprisingly voted against the interests and needs of their constituents with their passage of the American Health Care Act,” said Gilda Z. Jacobs, president and CEO of the Michigan League for Public Policy. “Medicaid and the Healthy Michigan Plan are vital lifelines to quality healthcare for rural Michiganders and we hope the Senate will stand up for these programs and reject the House bill that would decimate coverage for these residents and people around the state.”

The House bill would effectively end the Affordable Care Act’s Medicaid expansion, known as the Healthy Michigan Plan in Michigan, under which 113,800 rural Michiganders have gained coverage. This is the fourth-highest number of rural enrollees of all states that have expanded Medicaid. Roughly one in five Michigan residents who have gained coverage under the expansion live in rural communities. The Healthy Michigan Plan has also expanded access to substance use disorder treatment at a time when many of Michigan’s rural communities have been ravaged by the opioid crisis. The League has been a strong supporter of the Healthy Michigan Plan in the state budget process as well as the federal healthcare debate.

The House-passed bill would roll back progress in coverage and harm rural providers by effectively ending the Medicaid expansion. Beginning in 2020, states would receive only the regular federal Medicaid matching rate for any new enrollees under the expansion instead of the permanent expansion matching rate of 90 percent. This would force states to pay 2.8 to 5 times more than under current law for each new enrollee. In seven states including Michigan, these higher costs would automatically trigger immediate or eventual termination of the Medicaid expansion, with no action by state policymakers necessary. Laws in these states either explicitly require the expansion to end if the federal matching rate falls or require the state to prevent an increase in state Medicaid costs.

The bill also would dramatically cut and radically restructure the entire Medicaid program through a per capita cap or block grant (see League fact sheet), putting coverage for seniors, people with disabilities, and families with children at risk across the state. In combination with ending expansion, the bill’s per capita cap would shift $17 billion in costs to Michigan over the next decade. Medicaid plays a particularly important role in Michigan’s rural communities, and these cuts would threaten access to care for rural residents, including by harming Michigan’s rural hospitals.

In addition, the bill would replace the ACA’s premium tax credit and cost-sharing protections with an inadequate tax credit that would make coverage unaffordable for many of Michigan’s rural residents. Nearly one in four Michiganders who buy their coverage in the ACA marketplace are from rural communities. The House bill would raise total costs for State marketplace consumers by $1,519, on average.

“The healthcare bill Congress sent to the Senate reduces coverage and raises costs for rural and urban residents alike, and we need to keep fighting to make sure this bill or any similar proposals stop dead in their tracks,” Jacobs said. “To that end, we will keep working to remind federal and state lawmakers of the human impact of their decisions on healthcare.”

The House bill also removes key protections that the ACA put in place nationwide to let people with pre-existing conditions get affordable coverage that provides the health services they need. These protections are especially critical to people in rural communities, who are more likely to have disabilities or die as a result of a chronic disease.

To learn more about this report, please visit: http://www.cbpp.org/research/health/housepassed bill- would- devastatehealth care-in-rural-america.

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