Affordable Care Act ruling: Where things stand for the state, Washtenaw County and you

Major provisions - including the individual mandate that came under question in the Supreme Court case - remain mainly untouched.

However, the court did strike down the provision that would cause states to lose Medicaid funding should they not expand the income thresholds for Medicaid as initially stated by the act.

Top state officials made statements against the Affordable Care Act in light of the Thursday ruling, including Gov. Rick Snyder and Attorney General Bill Schuette.

Schuette urged state lawmakers to delay implementation of the Affordable Care Act in Michigan Thursday, though Snyder said the state will move forward with the creation of health insurance exchanges.

With Thursday’s ruling, the states that did choose to not expand eligibility for Medicaid would only lose the federal funds that would have been used for expanded coverage.

One of the next benchmarks that will be implemented as a part of the Affordable Care Act that are statewide exchanges for individuals and companies to purchase insurance. The exchanges become effective Jan. 1, 2014.

Michigan legislators have previously received money to create the exchanges, but the House has stymied the acceptance of the money as they waited for the Supreme Court’s ruling before initiating the process.

The decision is one Marianne Udow-Phillips, director of the the Center for Healthcare Research and Transformation at the University of Michigan, said puts the state at risk for defaulting and letting the federal government run an exchange in the state.

Udow-Phillips is also heavily involved with the Washtenaw Health Initiative, a volunteer group working to prepare the Ann Arbor area for the implementation of federal health care reforms under the Affordable Care Act.

The city of Ann Arbor was recently asked to contribute $20,000 to funding the health initiative.

The exchanges would sell policies that offer particular important benefits that would be determined by a state board, at varying price ranges. Certain individuals and small businesses would be eligible for subsidies to purchase health insurance.

The purpose behind the exchange is to level the playing field for small employers to have a better choice of plans and insurance at a lower cost in the way large employers have.

In Washtenaw County, an estimated 30,000 people are uninsured, said Ellen Rabinowitz, director of the Washtenaw Health Plan. The plan connects uninsured, low-income residents with health care.

Once all the provisions of the ACA are fully implemented after 2014, the income thresholds for Medicaid enrollment will be expanded.

The threshold would be expanded to adults under the age 65 living below 133 percent of the poverty line.

Two-thirds of the 8,000 people the Washtenaw Health Plan serves will become eligible for Medicaid.

The majority of the uninsured are between the ages of 18 and 65, Rabinowitz said.

Rabinowitz broke it down for what it means in terms of Washtenaw County residents:

• 13,000 people will be newly eligible for Medicaid
• 11,000 people will be eligible to purchase insurance through an exchange
• 5,000 people will remain without insurance

Details about how the influx of people newly eligible for Medicaid will be able to access the program are still being worked out at the state level, Rabinowitz said.

About 2,700 people in Washtenaw County are eligible for Medicaid under the current income thresholds and aren’t enrolled. Workers at the Washtenaw Health Plan are focused on reaching as many of those people as possible before 2014, Rabinowitz said.

With the full extent of the healthcare reforms and more people enrolled in Medicaid, Rabinowitz estimated that fewer individuals will need the health plan services.

It's also estimated there could be as many as 34,545 additional primary care visits annually in Washtenaw County, a demand WHI leaders have said is not likely to be absorbed easily.

The University of Michigan Health System and St. Joseph Mercy Ann Arbor have made adjustments to improve their efficiency that help with accommodating the impacts of the Affordable Care Act, regardless of the Supreme Court's decision.

Many private health care providers don’t accept Medicaid, and even fewer dentists accept Medicaid patients, Udow-Phillips said.

The federal government will pay the difference between Medicaid payments and private insurance payments in 2013 and 2014 as an incentive, Udow-Phillips said. The state could absorb those payments in 2015.

At the individual level, the provisions in the ACA remain the same. Here's how they will affect you:

• Insured through your employer? Not much will change, although if a company is small enough they may decide to stop offering insurance.
• Uninsured, but employed at a business with more than 50 people? Businesses with more than 50 employees will be required to offer health insurance starting in 2014, or face a $2,000 penalty per worker. If you don't get insurance after 2014, you may face a penalty.
• Uninsured? You may become eligible for Medicaid, if in the correct income threshold. You may receive a subsidy for health insurance, available through an exchange. Again, no insurance after 2014, you may face a penalty.