After two years, hard to call ACA anything but a success

It is hard to believe that as the Affordable Care Act turns five on March 23, it continues to be as controversial as it was on day one. The U.S. House of Representatives has taken 56 votes to repeal all or some of the landmark health care reform law, most recently in February. Earlier this month, the U.S. Supreme Court heard another ACA case with significant and far-reaching implications for the law’s future. Governors and legislatures across the country are continuing to debate whether or not to expand Medicaid. And legal and policy debates about contraceptive coverage and other components of the law are ongoing with no end in sight.

Yet against great odds, the ACA is having a profound effect on coverage and care across the country and in Michigan.

The second year of the ACA’s individual health insurance market coverage expansions came to a formal close on February 15. The first year of the Medicaid expansion in Michigan ends on March 31.

What has been the ACA’s actual impact in Michigan?

The answer is in the numbers. While there have certainly been negative effects for some individuals and businesses, it is hard to argue that the ACA’s coverage expansions, health system reforms and economic impacts at large have not positively affected hundreds of thousands in our state (and will be a topic of discussion at our Center’s March 26 symposium).

One has only to add up the numbers:

In Michigan, about 272,000 people received individual coverage through the Health Insurance Marketplace in 2014, blowing through all predictions made at the federal level. In 2015, Michigan exceeded 341,000 covered through the Marketplace. In 2014, 87 percent of these individuals have received a subsidy (making the upcoming U.S. Supreme Court case on this issue profoundly important). Many now covered on the Marketplace were able to get health insurance for the first time.

By early March, more than 579,000 people received coverage under the Healthy Michigan Plan, the state’s expanded Medicaid program, exceeding the state’s first-year enrollment predictions in just 10 months. The vast majority of these individuals were also uninsured before the expansion.

Data shows that despite some predictions otherwise, employers have not dropped coverage as a result of the ACA. In fact, employer-sponsored coverage continues to be the way most U.S. employees get their health insurance coverage. In 2014, 71.4 percent of non-elderly employees had employer-sponsored insurance nationally, up slightly from the 71.2 percent who had it in 2013.

As a result of these coverage changes, Michigan’s uninsured rate dropped by half between 2012 and 2014, based on CHRT’s most recent survey of Michigan adults. It does not appear that patients are experiencing access problems as nearly 9 out of 10 survey respondents (87 percent) reported that it was not difficult getting a primary care appointment.

Michigan has received almost half a billion dollars in federal funding for grants and demonstration projects since the ACA’s inception. These funds have gone to efforts such as increasing access to care at federally qualified health centers, expanding early childhood home visitation programs, and implementing new models of innovation like the grant recently awarded to the state for $70 million to test a variety of approaches to improving coordination of care and innovations in reimbursement.

Hundreds of providers across the state are testing new models of reimbursement and care integration under the ACA through initiatives like Accountable Care Organizations and bundled payment demonstration projects. The federal government extended one of these initiatives, the Michigan Primary Care Transformation Project, for another two years because it demonstrated first-year savings of $148 per beneficiary for Medicare alone.

In light of these real, tangible and measurable accomplishments, it is hard to understand why the focus by some in Washington continues to be on getting rid of the law rather than strengthening it.

There is no question that the ACA is complicated and needs changes to fully achieve the goals it set out to accomplish. But in just five years, the law has given hundreds of thousands in our state a chance they never had before: access to health care.

Let’s not lose that focus as we go forward in 2015 and beyond.

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Chuck Fellows
Sun, 03/15/2015 - 6:49am
To paraphrase the consequence of JFK's vision, that's one small step for health care, one giant leap for Michigan. And instead of negativity we must all engage in a productive dialogue to proactively improve health care one small step at a time. Always ask your health care provider "Why?".
Leon L. Hulett, PE
Sun, 03/15/2015 - 10:50am
Chuck Fellows March 15, 2015 at 6:49 am Here is a simple thing that would improve health care. A simple step that we might discuss. There is a simple health care system for domestic animals. It is called Minerals. It would work for human health as well. It goes like this. There is a state law requiring 3 pounds per ton of elemental Selenium in Pig Feed. This is an essential mineral, it is required for humans to live. The same amount is probably true for humans. Pigs get white muscle disease, a disease of the heart where the deficiency causes weakening muscles and they appear to be a white color. In Humans this exact disease is called cardiomyopathy. Domestic Pigs don't get this illness when they get selenium. Humans that do not get selenium do get this fatal disease, about 92,000 Americans die of it per year. Young athletes that keel over on the football field or basketball court, or those that sweat a lot, often have this. It is preventable in humans with a mineral. Michigan soils are nearly devoid of this essential mineral, so is the food we grow on these soils. A simple state law, costing no taxpayer dollars, saying that people will have this same level of health care would solve many of the health issues facing people in Michigan.
Wed, 03/18/2015 - 2:47pm
I'm not one to read 'comments,' but yours was well worth the read. Thank you for the positivity about one of our countries most important laws of the land !! 8)
Leon L. Hulett, PE
Thu, 03/19/2015 - 6:07am
Pam March 18, 2015 at 2:47 pm Thanks for your kind thoughts and taking up the dialog on health issues. It seems to me veterinary medicine is about 50 years in advance of Human medicine when it comes to minerals. Farm animals may remain healthy their entire lives and never see a veterinarian. At least mine did. That is a great health-care system. Can you imagine a Human system where our soils and the produce from them were so healthy that few illnesses remained? That would be Health Care System to admire!
Sun, 03/15/2015 - 7:31am
I take issue with your reporting. Numbers are only meaningful with a close explanation. I personally have less coverage and 2.5 times higher premiums not to mention higher co-pay. Finding doctors who accept new patients is also a challenge I have found. This is the world of many that no one wants to admit. Have you talked to people who had good plans before ACA??
Mon, 03/16/2015 - 7:10am
I agree that the people that had coverage prior to ACA may be the ones with the greatest negative effects. Personally, we saw a raise of 41% in our premium, raised deductible, raised out of pocket costs and less coverage. ACA is not working for my family; it has caused us to receive less healthcare with significantly greater costs.
Sun, 03/15/2015 - 8:20am
What I find discouraging is that there are still Doctors that work in hospitals and do not participate with your insurance company. I have BC/BS and Medicare. Twice now I have gotten bills from Doctors foe $2000, and $600 because they didn't participate, what is even worse is the facilities did not tell you at the time of treatment and had you sign a statement that you would pay all costs not covered. This is just plain wrong. . Love to hear comments on this. R.L.
Bruce McFee
Sun, 03/15/2015 - 10:23am
There's nothing new about facilities not telling you about the cost at the time of treatment. You can find millions of Americans that got medical bills months after the treatment, and that practice was going on before Obamacare existed. I don't know of any other industry that works this way.
Teri Olson
Sun, 03/15/2015 - 1:13pm
I successfully dealt with this problem by refusing to pay for physicians' services in a BCBSM-participating hospital when the non-participating physicians did not disclose in advance of any services that they were not BCBSM participants. The terms of an oral contract with such a physician can be binding only if reasonable from the point of view of an ordinary person, who cannot be expected to interrogate everyone who enters the room and provides:"service." (E.g. the nurses? the cleaning personnel?) They gave up. Check with a lawyer.
Sun, 03/15/2015 - 9:40am
This article is certainly heartening when it cites statistics showing some persons are benefiting from changes that, to some extent, are part of ACA. However, it vastly understates the negative effects on workers and, especially, small employers. Let's acknowledge first the good news. Expanded Medicare (not the central part of ACA, only implemented in some states, and heavily dependent on time-limited federal subsidies) is clearly a benefit to Michigan. It was the very capable Jim Haveman who was largely responsible for convincing the state legislature to participate in that program here, at least for the time being. Jim, who served as a department director in Michigan under two Republican governors as well as in Iraq, just retired. Now, some bad news. It is really not correct to say that "data show" that employers are not dropping coverage. Overwhelming data show otherwise. First, on the aggregate data, employer-sponsored coverage began declining before ACA adoption. ACA has increased that trend. One set of statistics show private sector firms offered health insurance 59% of the time in 2000, dropping to 50% by 2012. Among small firms offering entry-level wages, the "offer rate" for health insurance declined a drastic 31% to 18% during the same time. (Data from National Institute for Health Care Management Research and Educational Foundation, see Lest one think these statistics are from a biased source, the liberal EPI think tank estimates that ESI among under-65 adults dropped from 63% to 58% from 2007 to 2011. (See Second, repeated rule changes affecting eligibility and subsidies have caused government estimates of the effect on employer-sponsored coverage to drop, and then drop again. (See, e.g., CBO estimates at various times in 2012 and 2013). Third, ultimately, it is employers--not governments or academics--that make the decision about coverage. Numerous well publicized episodes demonstrate the harshly negative effect of ACA on some employer's decisions. Examples of this include UPS, University of Virginia, and many others. Of course, such events could be non representative. Thus, one should attempt to look at employer sentiment on a broad basis. Perhaps the most authoritative and wide-ranging source is the Fed beige book, which summarizes surveys from multiple Federal Reserve Banks, each of which are under different management and have somewhat different survey practices. Below is a link to the reports and a blog post summarizing them, largely from 2012 and 2013. These consistently report employer fears regarding the ACA across the country, and resulting negative effects on employment and costs. The most recent report, March 2015, seems to show this easing. However, it also notes (this from the 11th district) that "most staffing firms said they had raised billing rates to offset higher costs associated with the Affordable Care Act;" and (the 1st district) "main factors expected to affect business in the coming months include health insurance costs from the Affordable Care Act..." (See: and Fourth, my own research (which I am putting at the bottom and reserve for only the hardy souls that have slogged this far!) provides a clear basis for why small firms, in particular, were dropping health coverage during the 2010-2013 period. You can find it in the journal Business Economics here: It also cites additional data on employer reactions to ACA. I am glad Bridge is looking at this, and I am in agreement with the learned author of this article that there are good things associated with ACA implementation (broadly construed) in Michigan. However, we cannot avoid recognizing the very negative consequences for many workers and employers. Those should also be part of the debate about how to go forward. PLA
Sun, 03/15/2015 - 10:38am
Thank you Bruce. I am not bad mouthing the ACA. Quite frankly I don't understand it and I truly believe few of us do. If it affects us personally then you have every reason to be concerned. Medicine is very complicated and difficult to understand. I know people who are insured paying $3000 to $4000 a years for coverage and have 10,000 deductible and high co pays. They are hopelessly in debt because of having a baby, kids in the hospital and Dr. visits. Those with no insurance or Medicaid get the same care and pay little or nothing. Something has to change. R.L.
Sun, 03/15/2015 - 2:57pm
Thank you Patrick Anderson for your comments and references to back them up. The author of the article seems to be looking through "rose colored glasses" and only picking what she perceives as some positive outcomes of the ACA. There are numerous other items beyond what Patrick quotes such as hidden taxes on employers, brokers and insurance companies just to mention a few. Thank you R.L. for you comment about people who are getting insurance with such high deductibles and co-pays and therefore face staggering bills. I also read an article that many in this situation are forgoing care other than covered preventative measures because of the high costs. And as you mention R.L. those with no insurance or Medicaid pay little or nothing. Someone has to bear these costs which means those with insurance are going to have higher premiums. And if the government pays a subsidy so someone can have coverage that money has to come from somewhere which is the taxpayers or increasing the debt. So yes, there are some perceived positives to the ACA. However a good author with no bias should be including the negatives that have come along with this act that was passed on a completely partisan basis and late at night before our legislators had a chance to analyze the several thousand pages in the bill.
Sun, 03/15/2015 - 5:59pm
Bob simply does not know what he is talking about. No bill has ever been so closely studied as the ACA. Hundreds of changes were made to weaken the bill because Republican senators said they would not vote for it unless the changes were made. The bill was stalled for months while rightwing opponents spent over $400 million in disinformation campaigns, including the infamous "death panels". Ted Kennedy's death during this time threatened to leave the Dems a vote short. In fact, the public option was removed for the loss of a blue-dog democrat who feared re-election if it was part of the "private enterprise" bill. After hundreds of changes, not one Republican who said they would vote for the changed bill did so, in perhaps what was the greatest exercise in deception and hypocrisy ever for members of the U.S. Senate. If nothing else, this made it clear that the Republican senators could not be trusted. After the fact, it became clear that everything the Republicans had negotiated was intended to weaken and kill the bill. Bob should realize that besides having huge staffs to read bills, the opponents had several billion dollar "think tanks" working to study, undermine and destroy the ACA. Bob's insinuation that this bill was somehow snuk through in the middle of the night is as ignorant as it is laughable.
Mon, 03/16/2015 - 2:19am
John you are losing credibility after your second sentence. NO REPUBLICAN VOTED FOR IT - PERIOD. So to try and sell changes to appease the GOP is a flat out lie. How about the 30 some times Obama unilaterally and imperially changed existing law with no action by Congress?
Reality Check.
Sun, 03/15/2015 - 5:16pm
And the best part is if you like your plan, you can keep your plan..Oh sorry I forgot. How about the highly efficient and cost effective website right, that didn't work out so well. But I'm sure all the people who were happy with their plans who were dropped and had to go to the exchanges and get new higher cost plans are happy...oh right, they're not. I'm also sure that all of the physicians who are looking at a $.20 on the dollar reimbursement under Medicaid are saying "Yeah! Sign me up!"... Oh yeah, doctors are dropping out in droves. So yes it's been a huge success. I can't wait for more centrally dictated, top down solutions, they always seem to work the best.
Mon, 03/16/2015 - 2:17am
More liberal dribble.......sell it to your like minded drones - those of us with a brain that are still capable of independent thought aren't buying it. Mr. "Check" is spot on !
Bob Balwinski
Sun, 03/15/2015 - 7:29pm
The insurance companies aren't complaining. Hospitals are not complaining. The growth rate of medical costs is lower. There is decreased use of ERs for basic care. I believe the "bugs" will be worked out and all will work out in the end. Nothing has ever turned out perfect and no plan of action has ever been win-win for everybody. Don't let "perfect" be the enemy of "pretty good." My friend with a pre-existing condition thinks the ACA was heaven sent. Anecdotes, good or bad or neutral, are just that. You don't judge an entire change of scope because something has gone wrong or gone right for a person or a small company. Let's fix what needs it and move on. The medical world before the ACA is not worth returning to.
Mon, 03/16/2015 - 10:53am
finally, a comment here that makes sense!
Sun, 03/15/2015 - 8:42pm
It's difficult to slog through it all, for sure. I'm not convinced that a true causative effect exists between the ACA and the rising costs of health care, insurance, higher deductibles, and so on. That was happening long before the ACA and just about as fast. I'm also not convinced that employer reaction is actually because of the law or because of their fear of the law. And I think other larger companies took advantage of the confusion to justify doing what they wanted to do anyway, which was screw their employees some more so their upper management teams could get bigger bonuses. That's the way corporate America seems to operate these days, regardless. In any case, it seems the ACA certainly has been a boon for the insurance industry.
Mon, 03/16/2015 - 2:14am
You are completely delusional. Soaring deductibles, double and triple premiums, forced policy changes - you call this a success? WORSE YET - the American people don't want it. Survey after survey, poll after poll proves it. It's another example of an out of touch elitist government not listening to its constituents. REPEAL IT ALL and start over.
Mon, 03/16/2015 - 11:03am
"Soaring deductibles, double and triple premiums, forced policy changes" are true mostly for people who had junk insurance before ACA. And for the most part these stories are only appearing on Fox "News." And like everything else on Fox, they're about as believable as a Bill O'Reilly travel itinerary. As for the American people not wanting it, that's only a product of Republicans being very successful at lying through their teeth about what's in "Obamacare." (Death panels, etc.) When you break out the components of the ACA -- no more rescission (that's the retroactive cancellation of insurance after you get sick), no more pre-existing condition exclusions, kids able to stay on mom and dad's coverage until they're 26 -- people overwhelmingly support it. They just believe too many lies about "Obamacare" to support that (largely nonexistent) awful stuff.
Mon, 03/16/2015 - 11:46am
Republicans claimed incessantly that Obamacare would "wreck the economy". Really? I guess they failed to check the job growth stats and the stock market, both setting records. And all we heard for years was Republicans claiming the law was unconstitutional -- not only did that prove untrue, not only were they wrong again, but the chief justice -- a darling of the right wing -- said they were wrong. Right now, millions of Americans -- many in minimum wage jobs close to the poverty line -- go uninsured because Republican states have refused to accept the Medicaid extension -- paid %100 for the first two years and %90 thereafter. Thank god the hospital lobby and the Chamber of Commerce had enough sway with Snyder to get this part in Michigan. An anecdote -- a co-worker of mine was hospitalized for his drug addiction, is off drugs and getting treated and medication to stay off. He is incredibly happy to no longer be living the lie. Thank you Snyder for being a compassionate Republican and not one of the right wing nuts.
Leon L. Hulett, PE
Mon, 03/16/2015 - 1:34pm
john March 16, 2015 at 11:46 am You said, "I guess they failed to check the job growth stats..." Let's check'em: Population now: about 320 million (current Census Population Clock) 18 and above: about 240 million (2010 Census 18 and above/population times current population) at 40 hours per week that would give about 9600 million hours per week that could be employed, this week. Right? So the "Employable" hours is 9600 million/week. the Employable equals the Unemployed hours plus the Employed hours. Employed hours is 157 million times 34.6 hours per week equals: 5432 million hours/week. So the Unemployed hours this week is roughly 9600 - 5432 or 4168 million hours. So I think the actual "Unemployment Rate", 4168/5432 expressed in percent, is about 77%. Things could be better. Now, you may have been thinking of the Job Growth for last year of 3.1 million jobs. That, does not contain the 2.8 million new people to the job market. That gives a net of 0.3 million job growth for our population. 0.3 million jobs times 34.6 hours/job-week gives 10.92 million hours per week in job growth. 10.92 million actual growth/4168 million actually needed this week gives an actual job growth of 0.0026...for all of last year! I'm saying the actual job growth last year in America was unimpressive. I remain...unimpressed. Our major competitor, China did have an impressive job growth last year. Their economy exceeded ours last Dec for the first time ever. They have had 30 years of 10% growth per year. We are no longer the biggest super-power economically. Where would place America's economic future compared to China's, based on your "job growth stats?"
Allan Blackburn
Sun, 03/22/2015 - 7:59pm
Since we shipped a great many manufacturing jobs overseas it's no surprise that China is doing well.
Thu, 12/24/2015 - 2:27pm
Wow, interesting numbers. Interesting, but not at all relevant. I guess college students are unemployed. Housewives are unemployed. The disabled are unemployed. Early retirees are unemployed (this being Michigan, there are many in their 50's who were union ant took their 30 and out. Auto workers, police, firemen, steel workers etc,). My heart bleeds for those poor unemployed people, people like Mitt Romney, Jeb Bush, and Mike Huckabee who are starving because they can't find a job. Are you really dumb enough to believe your own argument?
Harry Hammond
Mon, 03/16/2015 - 6:43am
While it is true that millions have insurance through the marketplace, it is also true that the coverage is typically $6000 deductible with 80-20 copays. My wife and I have coverage, but are still afraid to use it. Furthermore, we receive a marvelous subsidy in the form of the advanced premium tax credit. If only 150,000 families received the APTC in the amount of $600 per month, that would mean the federal government spends close to a billion a year subsidizing coverage, just in Michigan. Before declaring success, many difficult questions need to be asked and answered.
Mon, 03/16/2015 - 8:03am
I also question the unqualified success. I am personally paying a much higher premium, but rarely see benefit due to 8X higher deductible. In addition to the higher deductible and higher co-pays, the coverage itself it does not fit our family as well as the pre-ACA did. Because, we were not allowed to keep that plan. You can write this article again and again, does not make it true for the vast majority of us.
Susan Leithauser-Yee
Mon, 03/16/2015 - 8:38am
The ACA seems a success as measured by a reduction in the number of uninsured citizens. I also vigorously support its encouragement of high deductible plans which give individuals an incentive for managing their health maintenance costs and its role in making health insurance more available to entrepreneurs & others who don't have coverage through an employer. It is not perfect, e.g. it does little to reduce overall health care costs, but I have yet to hear any better alternative proposed. Of note, to the extent that I have a political affiliation, it is Republican/Libertarian. Consumer choice puts power in the hands of the individual.
Mon, 03/16/2015 - 1:51pm
I was told ,over and over again at the hospital that they can not give the name of the Dr. on duty in E>R. and that they can not say if the Dr.accepts your insurance. You must sign that you will pay any and all bills if not covered. What's wrong with this picture. The bill from one was 2000, and another$600 R.L.
Thu, 03/19/2015 - 11:00pm
Our family had good coverage through my husband's employer, and we were able to "keep" our plan. However, premiums increased, and co-pays for all but office visits increased by a huge percentage. As an example, a recent office procedure for which we would previously have had a $25 co-pay now has a $150 co-pay. Most of those I know with coverage through the marketplace have preventative care covered, which is a good thing, but as many others have commented, their plans are high-deductible plans that are rarely used because they cannot afford to pay the out-of-pocket costs before the deductible is reached. And the bottom line is that someone has to pay for all of this. I assume that our higher premiums and co-pays go to cover all the preventative stuff that now has to be offered free of charge, so it is not "free." I also resent having to pay for a certain level of care for things I do not need. I am a post-menopausal woman -- why do we have to have coverage for pregnancy, birth control, well-child care, etc.?
Robert Mack
Fri, 12/25/2015 - 10:28am
Typical Liberal B/S and what else would we expect. If you like your doctor you can keep him, if you like your health insurance you can keep it and it will cost you less. What does it matter? (that 4 soldiers died) I did not Email secret government information. Democrats all lie all the time. Doctors are leaving their profession, they cannot afford ACA. Health Insurance Providers are opting out they cannot afford ACA and we have read numerous stories of families that cannot afford their rising premiums and co-pays. Tell it like it is, another Obama failure. Socialism does not work, we have had at least a century of that history. Take your head out of the sand!
Reginald Raleigh
Sun, 12/27/2015 - 5:26pm
Anyone who believes Obama Care is a success is a coolaid drinking moron!! Amazing!!!
Mon, 12/28/2015 - 3:18pm
The ACA was not fully implemented until 2014 and not even passed until 2010. I have noted some claiming companies were dropping coverage, supposedly due to the act, well before that. Some who claim they had better coverage, that was much cheaper, may have been surprised if they had been faced with a serious illness or accident.Many times people who thought they had good insurance had to proclaim bankruptcy when they discovered otherwise. I agree some policies have deductibles that are too high but I have also heard from others who have not had this problem. This " having skin in the game " was pushed by the Heritage Foundation and the AEI but hurts those with low or moderate incomes and may cause them to forgo care. The maximum allowable should be changed.