What's Wrong With The Senate Health Care Bill?

UPDATE:  On 6/27/2017, Senator Mitch McConnell, facing mounting opposition, announced that he will delay a vote on his legislation to repeal the Affordable Care Act until after the Senate’s Fourth of July recess. However, after the July 4th break, this bill could come back, in the same or a slightly different form. If you are looking for sources to follow the debates on an ongoing basis, find them here.

The Congressional Budget Office released their analysis of the Senate Republican plan.  Here is what the bill means. 


22 million more Americans
would be uninsured by 2026.

New York Times, June 26, 2017 

New York Times, June 26, 2017 

The budget office projects that by 2026, 49 million people would be uninsured, compared with 28 million people if the current law remained in effect. (The total increase is 22 million due to rounding.) Note that the biggest increase in the uninsured comes in the first year, when it is estimated that 15 million people could lose their insurance.

15 million fewer people would
be enrolled in Medicaid by 2026.

New York Times, June 26, 2017 

New York Times, June 26, 2017 

The largest group to lose health insurance coverage would be people with Medicaid. In 10 years, the C.B.O. projects, there would be 15 million fewer Medicaid enrollees. In addition, Medicaid might cover fewer benefits, so even those who have Medicaid might lose certain types of healthcare.

Average premiums would decrease by 20 percent in 2026.  BUT the amount Americans spend on healthcare would be higher because plans would offer FEWER benefits and DEDUCTIBLES would be higher. 

Want to know how this bill will impact you?

Are you a WOMAN?          Do you have a PRE-EXISTING CONDITION?          Do you need MENTAL HEALTH SERVICES?        SUBSTANCE USE ABUSE?          Live in a RURAL area?        Planning to START YOUR OWN BUSINESS?        SELF-EMPLOYED?      

Compare Proposals to replace the Affordable Care Act with this tool from the Kaiser Family Foundation. 

Comparison tool from the Kaiser Family Foundation, June 27, 2017.

Comparison tool from the Kaiser Family Foundation, June 27, 2017.

Thank you and keep up the good fight, 

-Meredith Buhalis 

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Capping Federal Money for Medicaid to States Will Devastate Millions of People


This blog post is cross-posted from Public Health Awakened and addresses potential changes from repealing the Affordable Care Act- June 2017

Proposed changes to Medicaid will lead to:

  • More people getting ill or dying prematurely, including children.

Low-income children are less likely to die in childhood or adolescence when states expand Medicaid (Howell & Kenney, 2012; Wherry & Meyer, 2013). Cuts that Republicans suggest would end core services to keep kids healthy that past administrations on both sides of the aisle have supported and expanded, including: well-child visits and check-ups, developmental screenings, immunizations, and treatment for vision and hearing, oral health, lead poisoning, mental illness, addiction, autism, and behavioral health issues (Sharfstein, 2017). For low-income adults, expanding Medicaid is significantly associated with less death and better self-reported health (Sommers, et al., 2012). Cutting Medicaid will reverse these trends in children and adults.

  • More seniors unable to meet basic needs.

For seniors, including those who may struggle to make ends meet, have high medical costs, live in nursing homes, or live with the effects of a stroke, dementia, losing their vision, etc., Medicaid covers long-term care and basic services for everyday life — like eating, bathing, or doing laundry — that are not covered by Medicare (Kaiser Family Foundation, 2016).

  • Millions of people having health coverage taken away from them.

Estimates are that 14 million people would have Medicaid coverage taken away — more than half of the 23 million more who would be uninsured by 2026 under changes to health care proposed by many Republicans (Congressional Budget Office, 2017). This would reverse the recent expansion in coverage to millions of people under ACA.

  • Harder financial times for working people, people with disabilities, seniors and adults who already struggle to make ends meet.

Reduced Medicaid coverage will worsen health disparities for already at-risk populations. People who lose coverage will have to make tough financial choices and will be less likely to get needed health care, for themselves and for their children (Chatterjee & Sommers, 2017).

Currently Medicaid covers (Kaiser Family Foundation, 2017):

  • Pregnant women: 49% of all births are covered by Medicaid
  • Children: 39% of all children, and 76% of poor children
  • People with disabilities: 30% of adults with disabilities (excluding and 60% of children with disabilities
  • People in long-term institutional care: 64% of nursing home residents
  • People in treatment for HIV/AIDS: 41% of adult AIDS patients and 90% of children with AIDS
  • Wider disparities across states and geographies in access to care.

States with older and sicker residents, as well as rural states, will be most affected (Lambrew, 2005). Safety-net hospitals, nursing homes, and clinics in low-income and rural areas that rely on Medicaid funds may close, and there will be less care for all residents of these already-underserved areas (Kaiser Family Foundation, 2012). Even people who can afford care will have to travel further to providers, and the proposed changes would eliminate Medicaid transportation services. States will likely control costs by paying providers less, and over time fewer providers will accept Medicaid patients (Sommers & Naylor, 2017). In addition, setting the amount of money that states get from the federal government would “lock in” current disparities in Medicaid funding, eligibility, and benefits packages across states: states that currently have less generous packages would not be able to “catch up” to more generous states (Holahan, et al., 2017).

  • Cuts in health services or states paying more money in the long run.

Reduced Medicaid coverage would reduce access to health care but not reduce health needs. Instead, health care use would likely shift to more expensive acute care services (e.g., emergency departments). Furthermore, untreated health conditions would lead to more severe health needs, leading to higher costs in the long run. An uninsured child costs the community $2,100 more than a child covered by Medicaid (Children’s Defense Fund, 2017).


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Buenas Noticias: Medicaid Puede Ser Su Seguro Secundario

Una Tarjeta de Identificación de Medicaid

Una Tarjeta de Identificación de Medicaid

Hay muchas cosas buenas acerca de Medicaid - tiene cobertura médica, de visión y dental; copagos bajos; puede solicitarlo en cualquier momento; y usted puede utilizarlo como un seguro secundario.


Imagínese que tiene un plan de seguro de empleador, pero tiene un deducible alto, y tiene que pagar de su bolsillo por sus primeros $ 3,000 antes de que el seguro pague cualquier cosa. Si usted es elegible para Medicaid, Medicaid será el segundo seguro (lo que significa que su seguro de empleador se factura primero), y Medicaid recogerá lo que el seguro del empleador no cubre.

Medicaid como un seguro secundario puede reducir significativamente sus facturas!


Hay algunos otros beneficios, también. Por ejemplo, usted puede tener una buena cobertura médica, pero sin cobertura de visión o dental. Como seguro secundario, Medicaid puede pagar beneficios de visión y dental.

Nota: Medicaid no puede ser un seguro secundario para los planes de Marketplace. Si usted es elegible para Medicaid, no puede obtener cobertura de Marketplace subvencionada. Pero si usted tiene cobertura de empleador, a veces Medicaid como un seguro secundario puede ser muy útil.

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Necesita lentes? Medicaid lo Cubre


Su visión es importante y si tiene Medicaid, ya sea Healthy Michigan Plan, Healthy Kids, MIChild o un programa tradicional de Medicaid, puede obtener exámenes de la vista y lentes.

Los exámenes de la vista son una parte importante del cuidado de la salud. Los exámenes de rutina ocular pueden detectar problemas de visión, enfermedades oculares y otros problemas de salud. Para los exámenes de rutina usted normalmente visitara a un optometrista. Un optometrista realiza exámenes de la vista para detectar problemas de visión y de salud. Los optometristas también pueden brindar atención a personas viviendo con baja visión, atención antes y después de una cirugía y recetar gafas y lentes de contacto.



  • Medicaid cubre exámenes oculares rutinarios e integrales que pueden incluir una variedad de pruebas como pruebas de campo visual, dilatación pupilar, ceguera de color, glaucoma y muchos otros.
  • Medicaid cubre los exámenes de glaucoma para personas con mayor riesgo de glaucoma.
  • Medicaid cubre anteojos que incluyen los marcos, lentes, accesorios, reparaciones y reemplazos de gafas. [Para las personas de 21 años o menos, las gafas se pueden reemplazar dos veces al año si se rompen, pierden o se roban las gafas - de lo contrario, la regla es una vez al año.]
  • Medicaid cubre bifocales y trifocales, o para dos pares de lentes de visión única (visión de cerca y de distancia) si los bifocales no funcionan. Los lentes sobredimensionados, no lineales, multi-focales progresivos y las transiciones no son un beneficio cubierto de Medicaid. Sin embargo, si usted quiere comprar estos, usted puede pagar los costes adicionales.
  • Medicaid sólo cubre los lentes de contacto si se consideran médicamente necesarios y si no hay otro tratamiento alternativo. Si no son médicamente necesarios, pero usted los quiere, usted puede pagar por ellos por separado.
  • Medicaid cubre marcos de seguridad.
  • Las personas que seleccionan marcos y lentes que no están cubiertos deben pagar la diferencia en costo.
  • Medicaid también cubre los ojos de prótesis.



¿Qué pasa si usted está preocupado por perder la visión, dolor en los ojos u otras cosas que pueden indicar un problema ocular grave? Si tiene más problemas oculares graves (como cataratas, retinas separadas o glaucoma), necesita un oftalmólogo. Un oftalmólogo es un médico que se especializa en el cuidado de los ojos y la visión. Los oftalmólogos realizan exámenes oculares, diagnostican y tratan enfermedades, realizan cirugías y recetan medicamentos, gafas y lentes de contacto.

Un oftalmólogo es visto a través de su beneficio de salud física de Medicaid, y no su beneficio de la visión de Medicaid. Para acceder a un oftalmólogo, la mayor parte del tiempo necesitará una referencia de su proveedor de atención primaria, al igual como si necesitara ver a un cardiólogo, un alergista o algún otro especialista.

NOTA: Si tiene un plan de mercado o de empleador, por lo general cubrirá la especialidad médica de oftalmología (por ejemplo, si tiene cataratas), pero los anteojos sólo estarán cubiertos si tiene un plan de visión especial.


Para obtener una lista de los Proveedores de Visión que aceptan Medicaid, por favor llame a su plan individual o visítelos en los enlaces web y siga las instrucciones proporcionadas.


Número de teléfono 1 866-316-3784 (TTY: 711)
En línea: https://www.aetnabetterhealth.com/michigan/find-provider

  • Haga clic en Medicaid, MIChild, Healthy Michigan Vision
  • Haga clic en visitar VSP
  •  Haga clic en buscar un médico
  •  Introduzca el código postal, la ciudad y el estado
  •  Ingrese Medicaid para la red de médicos
  •  Haga clic en Buscar


Número de teléfono 1 800-228-8554 (TTY: 711)
En línea: http://www.mibluecrosscomplete.com/find-doctor.html

  • Haga clic en buscar un médico
  • Haga clic en la búsqueda avanzada
  • Introduzca la ciudad y el estado o condado, municipio
  • Para la especialidad haga clic en, optometría, optometrista
  • Haga clic en Enviar


MCLAREN HEALTH PLAN  McLaren Medicaid o McLaren Healthy Michigan

Número de teléfono 1 888-327-0671 (TTY: 711)

En línea http://www.mclarenhealthplan.org/medicaid-consumer/Find-a-Provider-medicaid.aspx

En línea: http://www.mclarenhealthplan.org/healthy-michigan-member/Find-a-Provider-medicaid.aspx

  • Haga clic en la optometría de tipo especial o
  • Haga clic en condado, aumente Washtenaw
  • Introduzca código postal
  • Haga clic en Buscar


MERIDIAN HEALTH PLAN  Meridian Medicaid o Meridian Healthy Michigan

Número de teléfono 1 888-437-0606 (TTY: 711)
En línea: https://corp.mhplan.com/en/member/michigan/meridianhealthplan/benefits-resources/tools-resources/provider-search/

  • Haga clic en más opciones de búsqueda
  • Introduzca código postal
  • Ingrese los resultados en un radio de 30 millas
  • Haga clic en optometría para optometristas
  • Haga clic en Buscar
  • Haga clic en el número de página



Número de teléfono 1 888-898-7969 (TTY: 711)
En línea: https://providersearch.molinahealthcare.com/Provider/ProviderSearch?

  • Para el plan de cobertura seleccione Medicaid / Healthy MI Plan / MIChild
  • Haga clic en buscar por condado
  • Introducir estado
  • Entrar condado
  • Para el tipo de proveedor, seleccione
  • Para la especialidad seleccione optometría
  • Haga clic en Buscar



Número de teléfono 1 877-892-3995 (TTY: 711)
En línea: http://www.americhoice.com/find_doctor/first.jsp?xplan=uhcmi&xtitle=Doctor

  • Desplácese a la parte inferior derecha y seleccione buscando la pestaña de beneficios de visión y haga clic en el enlace
  • Te lleva al sitio de VSP
  • Haga clic en buscar un médico
  • Introduzca el código postal, la ciudad y el estado
  • Ingrese Medicaid para la red de médicos
  • A continuación, haga clic en Buscar

-T. South Peterson


Otros Recursos

MIChild esta cambiando, y generalmente significara una mejor cobertura para los niños de Michigan.

Good News: Medicaid Can Be Secondary Insurance

Updated** Medicaid Dental: How to Use it and Where to Go...

Actualizado ** Entendiendo el Deducible de Medicaid, o "Spenddown"

Am I eligible for Medicaid? 

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Good Sources For Following Debates About The ACA and AHCA

Keeping up with the proposed legislation for healthcare can be difficult! With changes happening so quickly, it can be hard to understand the implications of healthcare policies for you and your family.

For example, we are currently tracking the American Healthcare Act, or the AHCA (H.R. 1628), which is sitting in the U.S. Senate. Check congress.gov to see the bill’s current position in the legislature. We also recommend finding trusted resources that will break down the more complicated aspects of the bill.

Trusted Healthcare Websites

Here are a few we like to use:

GU logo.jpg

Checking Facts

Social media is a great way to stay on top of the news if you don’t have time to sit down and watch the news or read an article. Just be careful of your sources! We recommend using Politifact (http://www.politifact.com/) or FactCheck (http://www.factcheck.org/) to check what politicians are saying.

Do You Like Twitter?

If you like twitter, many healthcare journalists frequently tweet relevant articles. You can even make a "twitter list" of favorite tweet-ers. Here are a list of trusted healthcare reporters and organizations who will keep you in the know:

Julie Rovner (@jrovner), Correspondent at Kaiser Health News

Charles Ornstein (@charlesornstein), Reporter at Propublica

Jonathan Cohn (@CitizenCohn), Correspondent at Huffington Post

Andy Slavitt (@ASlavitt), Former Administrator of the Centers for Medicare and Medicaid Services

American Medical Association (@AmerMedicalAssn)

Health Affairs (@Health_Affairs)

Kaiser Health News (@KHNews)

NPR Health News (@NPRHealth)

Last, but not least, you can and should follow us @CoverageCounts!

--M. Higgins

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Why is Medicaid Important to Older People?


The recent discussions in Congress about rolling back Medicaid expansion, capping payments or converting the program to block grants will have a significant impact on older Americans.

Overall, one in five adults is covered by Medicaid and half of those adults are over age 50.  

For people who are 50-64 and not disabled, they are eligible for Medicaid under the Medicaid expansion, or the Healthy Michigan Plan. So if the Medicaid expansion goes away, they will lose their access to Medicaid. 

For adults who are 65+ or who are disabled, the Medicaid program works closely with Medicare to ensure they have access to the care and services they need.  In fact, 11 million Medicare beneficiaries rely on Medicaid to cover vital long-term home care and nursing home services, to help afford their Medicare premiums and cost-sharing, and more.  

To find out if you are eligible for Medicaid to help with Medicare, call the Area Agency on Aging and set up an appointment with a Medicare/Medicaid Assistance Program counselor.  You can also look at the Medicare Savings Program (MSP) categories and income limit chart.  If you believe you are eligible, apply for Medicaid and indicate that you have Medicare. 

Whether a person wants to age in their home or an assisted living facility, Medicaid fills the gap in services not covered by Medicare by serving as the primary payer for nursing home and community-based long term services and supports (LTSS) which would otherwise be altogether unaffordable for low-income older adults and people with disabilities.  Two in three nursing home residents on Medicare are also enrolled in Medicaid and two-thirds of all Medicaid spending for people on Medicare is for long-term services and supports.

Medicaid also pays for most home and community-based services that allow seniors and persons with disabilities to receive support services in their home as opposed to institutions.

Medicaid has been shown to break down barriers to treatment.  Of adults 50-64 with Medicaid, 50% suffer from multiple chronic health conditions.  These adults are less likely to skip refilling their prescriptions meaning their health problems are addressed instead of becoming the source of expensive hospitalizations.  Medicare recipients can qualify for Extra Help with their prescriptions.  The program is similar to Medicare Savings Program and you must apply.  Contact the Medicare/Medicaid Assistance Program.  

Federal cuts to Medicaid brought about by per-capita caps or block grants would drive states to make hard choices, likely leading states to scale back benefits, impose waiting lists, implement unaffordable financial obligations, or otherwise restrict access to services for older adults.

Adapted from Community Catalyst

Read more about Medicare/Medicaid programs

At the Washtenaw Health Plan, we can help you apply for the Medicare Savings Program.  We can also make appointments for you here with a Medicare/Medicaid Assistance Program counselor.  Call to make an appointment 734-544-3030 or just walk-in Monday through Friday 9am-4pm.  


-Meredith Buhalis

Leave a question or a comment below and WHP staff will respond.  

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The AHCA: Who Loses?

Medicaid Expansion and Current Medicaid Funding

One of the provisions of the Affordable Care Act allowed states the option to expand Medicaid to cover adults under 138% of the Federal Poverty Level who previously had little or no access to affordable health insurance.  From 2014 through 2016, the ACA’s Medicaid expansion population was funded 100% with federal dollars. Beginning 2017, states gradually have to pick up some costs, but the federal government still picks up 90% or more of Medicaid expansion through 2020. Medicaid programs that existed before the ACA are funded via a much less generous split between state and federal tax dollars.  

What is a Medicaid Block Grant? 

Medicaid is currently an entitlement program, which means that everyone who qualifies is guaranteed coverage. States and the federal government combine funds to cover the costs.  Conservative Republicans are currently endorsing a change to this funding called "block granting" which is included in the health care bill that recently passed the House of Representatives, the American Health Care Act (AHCA).  Instead of an entitlement, states would take control of the program and the federal government would cap what it spends on it each year.  AHCA supporters claim it will save the federal government money and give states more control.  It would be a drastic change to the current system and the Congressional Budget Office projections are that at least 14 million people would lose affordable coverage.


Who would lose coverage? how? why?


Working poor people who gained Medicaid under the ACA

14 million working poor people gained coverage under the ACA's Medicaid expansion program.  In Washtenaw County, over 17,000 people gained coverage. The AHCA would freeze funding for Medicaid by the year 2020, effectively ending Medicaid expansion. The AHCA would keep paying for people who signed up before January 1, 2020, but would not cover people who signed up after that date.  Many low-income people cycle on and off Medicaid as their employment changes seasonally, moves from part-time to full-time or as the economy fluctuates.  Once coverage ends, they would not be able to re-enroll.  

Seniors,  disabled people, and others who qualified for Medicaid before the ACA

The AHCA would adopt a policy known as a “per capita cap” for Medicaid that would hurt all beneficiaries. Currently the federal government matches state spending on Medicaid for everyone, not just those who get Medicaid under the Medicaid expansion. In 2020,  the AHCA would give each state a set amount of money per person and it would increase based on inflation, but it is not expected to keep up with medical costs. Consider the different costs to cover a 24-year-old, a 65-year-old and an 87-year-old. What would happen to the disabled, who need more coverage?  The federal government requires that certain populations are covered by Medicaid, but states would have to decide who would be covered with less money for Medicaid. States could spend less on Medicaid by removing either particular populations or certain types of benefits.


Pregnant Women and New Mothers

Under the AHCA, states could apply for waivers that would allow them to not cover the 10 Essential Health Benefits covered under the ACA.  Prior to the ACA, 88 percent of independent market plans did not cover maternity care.  Read more here: Essential Health Benefits Under the AHCA (ACA Replacement).


States hit hard by the opiate crisis

The opioid epidemic has many more patients needing substance use disorder treatment. A per capita cap would cause problems if an epidemic hit or if new, expensive medications became available.  Medicaid programs are currently covering many people receiving treatment for substance use disorder. If  Medicaid funds were capped any advances or new outbreaks would financially burden the state.  

People in states that take a Medicaid “block grant”

A full "block grant" would mean that states receive a fixed amount of money for Medicaid over a 10 year period, only increasing with the normal inflation rate.  There are no provisions to increase funds based on increased state population or economic recessions.  States could cut benefits or change eligibility requirements and many people would lose coverage.  

"Block grants" would encourage more states to "innovate"  alternatives to current Medicaid coverage. Michigan's current MIHealth Account requires all Healthy Michigan Plan participants to pay into a health account as a way of collecting co-pays for many services.  The amount is determined by prior usage of services and participants are sent payment coupons quarterly.  Participants do not lose coverage for not paying, but delinquent payments can be recouped from state tax refunds.  Indiana also has a waiver that requires participants to contribute before their coverage starts.  If they don't pay the premium they are locked out of Medicaid coverage for 6 months.  


People with Pre-existing Conditions

Under the MacArthur Amendment added to the bill in late April 2017, states would also be allowed to waive an ACA provision that bans insurers from charging higher premiums to sicker people.  We would return to the pre-ACA world of people with pre-existing conditions being charged much more for insurance.  Here is an estimate from Sam Berger and Emily Gee using data from CMS, the Center for Medicare and Medicaid Services.  

Families with Chronic Conditions

Because of the Essential Health Benefit waiver, states could also choose to eliminate  "lifetime limits," which let insurers decide how much they would spend on one person.  Before the ACA, most caps were between $1 million and $2 million.  These types of caps dramatically affect families with very ill children. Prior to the ACA, families went bankrupt trying to get healthcare for their children. 

Low-income Americans not on Medicaid

The ACA offered tax credits based on income for people to purchase insurance on the Health Insurance Marketplace (healthcare.gov).  Under the AHCA, tax credits are much lower for many people because they are based on age, and not on income.  In addition, there would be no cost-sharing. Under the ACA, people who are lower-income have cost-sharing--much lower deductibles and lower maximum out-of-pocket costs. Under the AHCA, those cost-sharing supports are eliminated.

Older People on the Health Insurance Exchanges

Older people would receive a bigger tax credit but the increase would not cover for the fact that they could be charged up to five times more than younger people. 

Children in Special Education Programs

Under per capita caps and block grants, Medicaid funded school programs for students with disabilities could be reduced or cut completely. Because special education requirements are mandated, schools would need to pay for special education out of general funds.

Planned Parenthood Patients

The AHCA includes provisions banning federal dollars from going to groups like Planned Parenthood.  So even though the majority of Planned Parenthood services are birth control, pregnancy and STD tests, as well as cancer screenings such as breast exams and Pap smears, the AHCA will deny women access to these services.  Planned Parenthood is the largest provider of reproductive health services in the country. In fact, in many places across the country, Planned Parenthood is the only birth control clinic. Without Medicaid funding (which does not pay for abortions), these clinics will be forced to close, denying millions of women access to health care.  

Almost Everyone Loses

Many provisions in this bill will make it easier for insurers to charge more for premiums, require more cost-sharing and shift costs to the consumer.  High income (over $250,000/year) people win and everyone else loses.

The Washtenaw Health Plan

believes that healthcare is a human right. The Washtenaw Health Plan board is on record opposing repeal and weakening of the Affordable Care Act.

Questions? Leave a comment below and we will do our best to answer.  

-Meredith Buhalis



Current Status of State Medicaid Expansion Decisions Map http://kff.org/health-reform/slide/current-status-of-the-medicaid-expansion-decision/

A 50-State Look at Medicaid Expansion  http://familiesusa.org/product/50-state-look-medicaid-expansion

Affordable Care Act Medicaid Expansion http://www.ncsl.org/research/health/affordable-care-act-expansion.aspx

State Medicaid and CHIP Profiles  https://www.medicaid.gov/medicaid/by-state/by-state.html

Everything You Need To Know About Block Grants — The Heart Of GOP’s Medicaid Plans  http://khn.org/news/block-grants-medicaid-faq/

These Are All the People the Republican Health Care Bill Will Hurt  https://www.vox.com/2017/5/4/15542990/republican-health-bill-ahca-medicaid-victims

An Early Look at Medicaid Expansion Waiver Implementation in Michigan and Indiana http://kff.org/medicaid/issue-brief/an-early-look-at-medicaid-expansion-waiver-implementation-in-michigan-and-indiana/

9 Things People Get Wrong About Planned Parenthood  http://nymag.com/thecut/2017/01/misconceptions-about-planned-parenthood.html

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Essential Health Benefits Under the AHCA (ACA Replacement)

What are Essential Health Benefits (EHB)?

The Affordable Care Act requires non-grandfathered health plans in the individual and small group markets to cover essential health benefits (EHB), which include items and services in the following ten benefit categories: (1) ambulatory patient services; (2) emergency services; (3) hospitalization; (4) maternity and newborn care; (5) mental health and substance use disorder services including behavioral health treatment; (6) prescription drugs; (7) rehabilitative and habilitative services and devices; (8) laboratory services; (9) preventive and wellness services and chronic disease management; and (10) pediatric services, including oral and vision care.
— The Center for Consumer Information & Insurance Oversight - https://www.cms.gov/cciio/resources/data-resources/ehb.html


Prior to the ACA, health insurance was not required to cover the benefits above.  Health insurance could exclude prescriptions, pediatric services,  hospitalization, maternity and prenatal care and mental health services.  The EHBs are also tied to the limits on consumer spending for these services.  Currently, out of pocket costs for an individual cannot be more than $7,150 and for families the cost cannot be more than $14,300. Under the AHCA, states could apply for waivers and the costs for EHBs would no longer be capped.   


Let's compare the benefits in the ACA to the AHCA. 

While it is true that your monthly premium might be less under the AHCA, if you live in a state that gets a waiver, all the EHB may not be included in your health plan. If your health situation changes, you could pay much more for services that are currently included in all health plans.  

An Example

For example, a state could remove coverage for maternity or newborn care from the essential health benefits. Prior to the Affordable Care Act, most health plans did not cover maternity care, and pregnant women would have to pay the full cost of prenatal care, labor and delivery. That could happen again. 

In fact, women's healthcare is particularly targeted. Under the AHCA, Planned Parenthood would not be able to get Medicaid reimbursals for pap smears, birth control, or cancer screenings. Since Planned Parenthood is the largest reproductive health care provider in the country, it is likely that removing them as a provider--with or without removing the essential health benefit of contraception--will mean many more unintended pregnancies. For middle-income women, over the income cap for Medicaid, the birth and expenses would not be capped so you could pay $15,000 or more for a birth with complications.

The AHCA--the "replacement" for the ACA--goes next to the U.S. Senate. If you support comprehensive and affordable health care, let your senator know that you oppose the repeal of the ACA. 

Have questions?  Ask them in the comments section and we will do our best to answer. Call 734-544-3030 or Walk-in to the Washtenaw Health Plan office Monday - Friday from 9am - 4pm.   

-Meredith Buhalis and Ruth Kraut

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Pre-existing conditions, the ACA and the AHCA

Under the Affordable Care Act (ACA) of 2014, health insurance companies can’t refuse to cover you or charge you more just because you have a “pre-existing condition” — that is, a health problem you had before the date that new health coverage starts. Health insurers can no longer charge more or deny coverage to you or your child because of a pre-existing health condition like asthma, diabetes, or cancer. They cannot limit benefits for that condition either. Once you have insurance, they can’t refuse to cover treatment for your pre-existing condition.
— U.S. Department of Health and Human Services https://www.hhs.gov/healthcare/about-the-aca/pre-existing-conditions/index.html

On May 4, 217 Republican Representatives voted to approve the American Health Care Act.  This Act is meant to repeal and replace the ACA.  One provision of this act is a change to the way pre-existing conditions are treated.  The bill in its current state does continue to cover pre-existing conditions under certain circumstances.  You must have continuous care.  Because this plan also removes the mandate that everyone must have health insurance, you can choose to not buy health insurance.  If you get cancer, you will have to pay a penalty and then you are allowed to get coverage.  The insurance company can CHARGE YOU whatever they want.  Let's just say that again.

Yes, you can have health insurance if you have a pre-existing condition but the health insurance company can charge you a lot of money. many people will not be able to afford that coverage.

High Risk Pools: We've been here before 

Click the image above to go to the video from Kaiser Health News 

Click the image above to go to the video from Kaiser Health News 

What about the high risk pools (HRP)?  What about them?  In the past, many states had high risk pools. They were extremely expensive, and many people did not get the care they need. Julie Rovner explains why this "sounds like a good idea" but isn't.  Sounds Like A Good Idea: High Risk Pools



If you are wondering what's included in the list of pre-existing conditions, so are we.  This is a partial pre-existing conditions list from CNN:  




Alzheimer's Disease

Amyotrophic Lateral Sclerosis

Anemia (Aplastic, Cooley's, Hemolytic, Mediterranean or Sickle Cell)


Aortic or Mitral Valve Stenosis





Bipolar disease



Cerebral Palsy (infantile)

Chronic Obstructive Pulmonary Disease

Cirrhosis of the Liver

Coagulation Defects

Congestive Heart Failure

Cystic Fibrosis

Demyelinating Disease





Esophageal Varicosities

Friedreich's Ataxia

Hepatitis (Type B, C or Chronic)

Menstrual irregularities

Multiple Sclerosis

Muscular Dystrophy

Myasthenia Gravis


Organ transplants


Parkinson's Disease

Polycythemia Vera


Psoriatic Arthritis

Pulmonary Fibrosis

Renal Failure



Sex reassignment

Sjogren's Syndrome

Sleep apnea



The Kaiser Family Foundation, a nonpartisan research group, has estimated that 27 percent of Americans younger than 65 have health conditions that would likely leave them uninsurable if they applied for individual market coverage under the system that existed before the Affordable Care Act. (New York Times, 5/6/17)  

One last point, this bill was passed by the House of Representatives and has a long way to go before it is signed by the President and becomes law.  Please make your voice and opinion heard by your elected officials.  It does make a difference. 

If you have questions, post them in the comments section and we will do our best to answer.  

-Meredith Buhalis

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What Is The Maximum I Can Make For...?

The Department of Health and Human Services begins using revised Federal Poverty Level Guidelines each April.  Many federally and state funded programs use the income guidelines to determine eligibility for programs and services.  Healthcare subsidy programs, Medicaid and Medicare all use the guidelines in their calculations.  The Federal Poverty Guidelines can be found here.

The chart below is what we use at the Washtenaw Health Plan to help people figure out what health care coverage is best for themselves and their family.  Our chart includes a 5% disregard.  We use the chart for determining eligibility for MAGI Medicaid. (What is MAGI?)

This is the document which includes disregards we use to determine eligibility for Medicaid, Marketplace tax credits and cost sharing, and other programs.  pdf

This is the document which includes disregards we use to determine eligibility for Medicaid, Marketplace tax credits and cost sharing, and other programs.  pdf

Our website has been updated with the new numbers.  Maybe you are very close to the edge of the income limit for MIChild or you need to check the income limit because you have a new baby.  Both Medicaid and MIChild have been updated.  Not sure where to go? Start Here

Many other programs use the Federal Poverty Guidelines as a baseline for their programs including:

Free and Reduced School Lunch Program

MOMS Medicaid is for pregnant women who are not eligible for full Medicaid because of their immigration status. 

Pregnancy Medicaid

WIC (Women, Infants and Children Supplemental Nutrition Program) provides food, nutrition counseling, and breastfeeding support to mothers and young children. 

Hospital charity care and financial assistance including M-Support and McAuley Support

Medicare/Medicaid programs help low-income Medicare recipients pay their health care costs. 

And many more! 

If you have questions, contact the Washtenaw Health Plan.  734-544-3030 or walk-in Monday through Friday from 9am - 4pm at 555 Towner St. in Ypsilanti. 

-Meredith Buhalis 

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