The Future of the Affordable Care Act

ACA repeal and replace graphicThe Trump administration and Congress are working to repeal the Affordable Care Act (ACA) and, ultimately, replace it. While imperfect, the ACA provides coverage and access to nearly 1 million Michiganders, and the MHA does not support dismantling these programs. The MHA is working closely with the American Hospital Association and others to continue providing coverage and access to high-quality and affordable care for all. This page provides tools, information and resources on ACA repeal, replacement and related topics. You can also read our recent ACA repeal and replace articles in our newsroom

Better Care Reconciliation Act Talking Points

Updated July 2017

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In June, Republican members of the U.S. Senate introduced the Better Care Reconciliation Act (BCRA), legislation designed to repeal and replace the Affordable Care Act. While the Michigan Health & Hospital Association is open to reforms to the Affordable Care Act, the association is opposed to the bill given the devastating effect if could have on hospitals, patients and communities throughout the state. In fact, the legislation poses a larger threat in Michigan and the country than the American Health Care Act, the bill approved by House Republicans earlier this summer.

Deep cuts to Medicaid in the Senate’s bill will devastate the health and well-being of Michigan residents

  • The Senate’s cuts to Medicaid threaten services for senior citizens, particularly those in nursing homes; children from low-income families; pregnant women; and individuals with disabilities. In this way, the bill is much more devastating to Michigan and the nation than the American Health Care Act approved by House Republicans earlier this summer.
  • There is no money in Michigan’s state budget to absorb a Medicaid cut of this magnitude; cuts this deep will impact every community in the state and threaten the economic benefits hospitals provide to communities, particularly – jobs will be lost and there will be a reduction in the availability of healthcare services
  • The plan threatens healthcare coverage and access to care for more than 1 million Michigan men, women and children who rely on such programs as the Healthy Michigan Plan, Medicaid or the state’s federally-facilitated exchange

Infographic: Uncompensated care would increase by $4 billion in Michigan hospitals in the next 10 yearsWe need to protect our state’s investment in making Michigan a healthier state

  • According to recent data from the American Hospital Association, Michigan hospitals alone face a $4 billion increase in uncompensated care costs under the Senate plan over the next 10 years. Such high uncompensated care numbers impacts patients’ access to care and drives up premium costs on private and public health insurance plans.
  • Michigan hospitals committed to a $10 billion reduction in Medicare payments to ensure state residents have access to expanded health insurance coverage under the Affordable Care Act. This amount represents Michigan hospitals’ commitment to the following:
    • Universal health benefits for Michiganders
    • Improved population health to reduce the necessity of sick care
    • Better care coordination to ensure the right care is sought in the right setting
    • Reduced emergency department utilization
    • Improved quality and patient safety
  • Michigan deserves its fair share from Washington, DC. Money our state sends to the federal government needs to be invested in our state to continue benefitting the health and well-being of our families and communities.

Rather than starting from scratch, Congress needs to fix the Affordable Care Act

  • Congress must engage in a process that is thoughtful and focused on ways to improve our healthcare system, particularly when it comes to vulnerable populations like seniors, children, the disabled and the poor.
  • The uncertainty created for patients, communities, insurers and hospitals under congressional attempts to repeal and replace the ACA is concerning and needs to be addressed before proceeding through the legislative process.
  • A responsible replacement should include:
    • The promise of federal support for Medicaid expansion at the current matching rate
    • A plan for keeping the individual health insurance marketplace stable and solvent
    • Eligibility assurances for people with pre-existing conditions
    • Protections against rescinding health insurance benefits after a person becomes ill

Despite the flaws in the Affordable Care Act, nearly 1 million people in Michigan now have healthcare coverage as a direct result of the law

  • Any changes to the Affordable Care Act must ensure continued healthcare coverage for Michiganders who have benefitted from the law.
    • More than 650,000 Michiganders receive health insurance coverage through the Healthy Michigan Plan (Medicaid expansion)
    • Another 320,000 Michiganders access health insurance benefits through Michigan’s federally facilitated insurance marketplace
    • In many Michigan counties, more than 30 percent of the population uses Medicaid for its healthcare benefit
  • Healthcare coverage is vitally important to working Michigan residents and their families. State residents rely on hospitals and health systems to provide them with:
    • A full range of high-quality, lifesaving services, including preventive benefits
    • Community education and resources that further improve the quality of their lives and the health of the communities in which they live.
  • There is ample evidence that the number of people in Michigan who are uninsured has declined substantially under the Affordable Care Act. However, many Michigan hospitals and healthcare systems are concerned about the risk of losing the coverage gains finally achieved under the Affordable Care Act and what that could potentially mean for the physical and economic health of patients and their families.

Listed below is a summary of the MHA’s major concerns with the coverage and access components of the BCRA:

  • Cutting Medicaid threatens care for vulnerable populations, including children from low-income families, the elderly and individuals with disabilities. The state budget cannot cover the costs of these cuts, so access to care and healthcare services will be impacted.
  • A provision allowing insurers to offer cheaper, slimmed down health plans as long as they offer one plan meeting ACA standards could severely threaten access to coverage for sick patients.
  • The latest version of the bill would end the innovative Healthy Michigan Plan and lead to more Michigan residents not having health insurance coverage.
  • The repeal of the insurance mandate for both individuals and employers, as well as several other taxes employed by the Affordable Care Act to help pay for coverage expansion, including the tax on health insurers, the medical device tax and more, without a realistic replacement for meaningful healthcare coverage.

For more information, contact Ruthanne Sudderth or Laura Appel at the MHA.

Important Resources and Updates


KFF Study Shows Insurers Regaining Profitability on ACA Markeptace Plans

The Kaiser Family Foundation released a study on July 10 based on first quarter financial data from 2017 that showed individual market insurers saw significant improvements in loss ratios, an indication that the market is stabilizing and insurers are regaining profitability. Insurer financial results show no sign of market collapse. The turn was driven by premium increases to adjust for a sicker-than-expected risk pool. However, the policy uncertainty created by continued debate in Congress over how to repeal and replace the ACA has the potential to destabilize the individual market generally.

Read the article

AHA Launches Ad Urging Congress to Protect Coverage

The American Hospital Association is launching a television ad urging Congress to protect health coverage for the most vulnerable as it considers legislation to repeal and replace the Affordable Care Act. The 30-second ad will begin airing the weekend of March 17 on national cable and in the Washington, DC, market.


Only 8% of MI Voters Favor Repealing ACA Without a Replacement

According to a new survey conducted by EPIC-MRA and released Feb. 15, only 8 percent of Michigan voters favor repealing the Affordable Care Act without the U.S. Congress and President Donald Trump first putting a detailed replacment plan in place.

2017 Healthcare Snapshots by Congressional District

The MHA has compiled a healthcare snapshot for each one of Michigan's 14 congressional districts. The snapshot provides an overview of the economic impact of healthcare in each district and the impact of enacted Medicare ACA cuts. It also lists the number of residents covered by the Healthy Michigan Plan by county as well as the percentage of county residents benefitting from Healthy Michigan Plan coverage.

What ACA Repeal Means for Michigan Hospitals

In a conversation on Stateside with Michigan Radio's Cynthia Canty, MHA Vice President and Chief Innovation Officer Laura Appel discusses the impact of an ACA repeal on the state's hospitals and individuals relying on either the Healthy Michigan Plan or Michigan's federally-facilitated marketplace for health insurance coverage. 

Report Outlines Impact of Potential ACA Repeal on Hospitals 

The American Hospital Association and the Federation of American Hospitals together released a report in December 2016 that details the impact a potential repeal of the ACA would have on hospitals and communities.

The report finds that, under the most recent repeal-without-replacement bill, H.R. 3762, hospitals across the nation would suffer losses amounting to hundreds of billions of dollars.

Hospital Commentary

Study Examines How the American Health Care Act will Impact Michigan

The Center for Healthcare Research & Transformation (CHRT) recently released an analysis of how key provisions in the American Health Care Act (AHCA) will impact Michigan. The U.S. Congressional Budget Office projects that 14 million American would lose their health insurance under the AHCA in 2018, with the number of uninsured rising to 24 million by 2026.


Economic Effects of Medicaid Expansion in Michigan

A study conducted by researchers at the University of Michigan has found that Michigan's expansion of Medicaid health insurance coverage has boosted the state's economy and budget, and will continue to do so for the next five years. The expansion's total economic impact will generate more than enough funds for the state budget to cover the cost of the program in the current fiscal year, the researchers report in a January 2017 New England Journal of Medicine article


MI Counties Most Vulnerable if ACA is Repealed

This Jan. 12, 2017, article from Bridge Magazine takes an in-depth look at the impact an ACA repeal could have on Michigan's population based on a county-by-county breakdown.

The MHA's David Seaman Discusses the Potential Impact of an ACA Repeal with WJR's Paul W. Smith

The MHA's David Seaman chats with WJR's Paul W. Smith during the WJR Live from Lansing broadcast Jan. 23.MHA Executive Vice President and Chief Operating Officer David Seaman sat down with WJR talk radio host Paul W. Smith during his 2017 Live from Lansing broadcast on Monday, Jan. 23. Seaman talked about the potential impact of an Affordable Care Act (ACA) repeal on Michigan residents, including those who currently rely on the Healthy Michigan Plan and Michigan's federally-facilitated marketplace for health insurance coverage. The MHA has been a sponsor of WJR's Live from Lansing broadcast since 2011, and once again had a featured radio spot during the broadcast.

Leading Michigan to Better Health

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