The Michigan counties most vulnerable if Obamacare is repealed

Hundreds of thousands of state residents would likely be affected by a repeal of the Affordable Care Act, including those in counties that went hard for the law’s critic-in-chief, President-Elect Donald Trump, according to a Bridge Magazine analysis of government data.

The implications of an immediate repeal of the ACA could be felt by nearly 1-in-10 Michigan residents, and as much as 13 percent of the population in places as different from one another as the Detroit-area and rural Emmet County.

Consider: In Wayne County, dominated by Democratic-heavy Detroit, 12.7 percent of county residents receive health care through a combination of ACA enrollment or Medicaid expansion. In Cheboygan County, at the top of the mitt, where Trump trounced Democratic nominee Hillary Clinton by a 2-to-1 margin, 13.1 percent of residents depend on ACA coverage or Medicaid expansion.

If the Republican-led Congress, with a likeminded president, also change the way that traditional Medicaid is funded, as many as two million Michiganders could be impacted by Washington’s dramatic health-care changes, enrollment data show.

Impact of ACA repeal in Michigan

Congress is considering repeal of the Affordable Care Act and major changes to Medicaid. Nearly a million people in Michigan get their health coverage through the ACA or Medicaid expansion, helping cut in half the percent of people who don't have health insurance. Click or tap on a county or congressional district to see how many people are covered by Medicaid expansion and the ACA.

By county

By congressional district*

*Estimates based on county-wide numbers. Some counties are split among two or more congressional districts. Source: State and federal health data on Medicaid and the ACA enrollment.

Trump is pushing Congress to immediately repeal “Obamacare” and congressional leaders have already begun taking votes to dismantle President Obama’s signature domestic legislative achievement.

It remains unclear whether Congress can agree on a plan to replace it immediately or at some point in the future. That uncertainty could leave many Michiganders facing the prospect of losing their health coverage, at least temporarily.

Bridge asked the state’s congressional delegation whether and how the ACA should be changed or repealed. Republicans, who hold 9 of the state’s 14 congressional seats, generally indicated they would move quickly to dump the law though, notably, no Republican spelled out whether they are willing to ditch Obamacare without a concrete plan to replace it.

“The president’s health-care law has led to double-digit premium increases, rising deductibles, and dwindling choices for consumers,” said one, Rep. Tim Walberg, R-Tipton, in a statement. “Obamacare is collapsing and families who are hurting need relief. To fix this broken system, we need to repeal Obamacare and have a stable transition to patient-centered health care solutions that give families more choices and lower costs.”

Half the state’s delegation – four Republicans and three Democrats – responded to questions posed by Bridge this week. Both U.S. Senators, Democrats Gary Peters and Debbie Stabenow, defended the ACA and, like others in their party, said they do not favor repeal but largely agree that the ACA can be improved, though they too weren’t terribly specific on how.

“The Affordable Care Act must be preserved. The evidence of its benefits are clear in our state,” Rep. Sandy Levin, D-Royal Oak, said in statement. “The protections in the law are also vital so that no one can be denied coverage because of a pre-existing condition or women are not charged more for their care.”

Republican congressmen Fred Upton of St. Joseph, Mike Bishop of Rochester and Paul Mitchell of Dryden sent general answers that criticized the ACA but offered no specific plans on how best to repeal, replace or change any elements of it.

Dems: Repeal not the answer

Since the ACA went into effect in 2013, the percentage of state residents without health insurance fell from 11 percent to 6.1 percent, according to U.S. Census data from 2015. It’s likely even lower today though, as Republicans are quick to note, premiums for ACA-bought policies continue to rise.

“The Affordable Care Act is not perfect but it has provided a significant benefit to working families across Michigan,” Rep. Debbie Dingell, D-Dearborn, said in response to Bridge’s inquiry. “We cannot afford to go backwards, and I will be fighting tooth and nail to protect the health care coverage” of those receiving coverage through the ACA.

More than 630,000 people were added to the state’s Medicaid rolls since early 2014, when the Michigan Legislature voted to expand coverage for the poor. The ACA offered additional federal funding to states to cover those making up $33,000 for a family of four or $16,000 for a single person. (The limit for traditional Medicaid is just below $25,000 for a family of four and $12,000 for an individual.)

The plan, approved by the Michigan Legislature with the vast majority of Democratic legislators and a minority of Republicans, went into effect in early 2014 and has seen hundreds of thousands sign up across the state. In many northern Michigan counties, the expansion doubled the number of people eligible for Medicaid.

Then, beginning in 2014, residents were able to buy private health insurance through the federal exchanges. As of late last year, more than 345,000 Michigan residents were covered by ACA-bought policies.

To ACA supporters, the number of beneficiaries – nearly a million across the state – should give Congress pause before it makes major changes to a program that benefits so many in Michigan and across the country.

“One would hope that the congressional delegation is responsive to its constituents,” said Marianne Udow-Phillips, director of the Center for Healthcare Research & Transformation, a nonpartisan health care research center based at the University of Michigan.

Rep. Debbie Dingell, D-Dearborn, says she will fight “tooth and nail” to maintain ACA coverage for her constituents

Benefits from…somewhere

Udow-Phillips, a former director of the Michigan Department of Human Services, acknowledged that the ACA has problems, including premium increases averaging nearly 17 percent, and needs to be amended. But she said it might get more support if more of its beneficiaries were aware of who they are. She said some who benefit from Medicaid expansion don’t know that they are benefitting from “Obamacare” in part because Michigan calls its expansion program Healthy Michigan” with no mention of Medicaid or the ACA.

“A lot of people didn’t realize they got coverage because of the Affordable Care Act,” she said. “Communication around this law has been terrible by advocates for the law.”

Indeed, news stories have appeared around the country indicating that some recipients don’t know the coverage they now have is a result of the ACA.

“I guess we really didn’t think about that, that he was going to cancel that or change that or take it away. I guess I always just thought that it would be there,” Debbie Mills, a Trump voter in Kentucky, told Vox. “I was thinking that once it was made into a law that it could not be changed, but I guess it can? Yes?”

The Senate took the first steps toward repeal this week, voting 51-48 to use the budget process to begin defunding the law. However, no plan to replace it has emerged, although individual pieces of a potential new health-care structure have been talked about for years. Republicans in charge of writing legislation to defund the ACA say no final decisions have been made, despite a Jan. 27 action deadline set by the incoming administration.

A vote for change

In Michigan, some counties with the highest Medicaid expansion and ACA usage gave Trump some of his largest victory margins (he won the state by just over 10,000 votes).

In Oscoda County, between Grayling and Lake Huron in northern Michigan, more than a quarter of residents get Medicaid – traditional or through the expansion – or bought a policy through the ACA. It’s one of the highest rates in the state. So too is the support it gave Trump, who received 70 percent of the county vote; Trump performed better in only two other Michigan counties.

Conversely, urban areas like Wayne County, where more than 30 percent of residents get Medicaid (traditional or through expansion) or bought an ACA policy, went for Democratic nominee Hillary Clinton in big numbers. She promised to preserve the ACA.

Charles Gaba, a Bloomfield Hills web developer, began collecting and disseminating data on the ACA in 2013 and has become a reliable source for ACA data to both the media and politicians. He estimates that two-thirds of those who bought a private policy through the ACA and all of those who are on the Healthy Michigan plan could be directly affected by repeal.

And that doesn’t count roughly one million state residents who benefit from traditional Medicaid coverage, which could also see substantial changes. Georgia Republican Rep. Tom Price, Trump’s pick as secretary of health and human services, has advocated turning Medicaid into a block grant program similar to welfare, which would send money to the states while giving them greater flexibility on how to spend it.

Those plans make some advocates for the poor nervous, in part because of how states, including Michigan, have historically handled other block grant programs. Bridge wrote last year about how some block grant money for the poor ended up funding scholarships at private colleges in the state for more affluent students.

Rep. Tim Walberg, R-Tipton, says he favors Obamacare’s repeal and a move toward a system that’s less expensive and with more options for families.

Change is coming

For critics of the ACA, Trump’s election has created an opportunity to focus on those who’ve been harmed because their premiums rose sharply, their insurance shifted to higher deductibles, or they lost job opportunities because of high insurance costs.

“It’s very easy when you talk about the possibility of repeal that you’ll be able to identify and swing a camera and find some people who would lose their coverage. It’s true and unfortunate. (But) right now the existence of the law has some very serious negative effects on a lot of people,” said Robert Graboyes, a senior research fellow focusing on health care at the Mercatus Center, a market-oriented research center at George Mason University in Virginia.

Noting that the plan has been far more expensive than expected, Graboyes said he is hopeful the ACA’s successor will tackle cost.

If regulatory controls on new drugs and treatments are altered, pharmaceutical costs could fall, he said. If hospitals are allowed to compete more, other costs could come down. He said savings from a “market approach” could pay for the health care coverage of millions. Instead, he said even Republican solutions are focused largely on how bills are paid – through insurance – rather than how those bills are comprised.

“And as long as all we talk about is insurance and the demand side we’re not going to get out of it,” Graboyes said. “But I’m confident that ultimately we will. To some extent we don’t have a choice.”

No clear proposal has emerged from the Republicans on what they plan to do. Price hasn’t been confirmed yet and Trump isn’t inaugurated until Jan. 20. Until they do or until a bill gets enough support in Congress, what happens next is almost anyone’s guess.

“I think it’s very, very hard to know at this point exactly what they’re going to propose,” Udow-Phillips said. “I don’t think they know what they’re going to propose yet.”

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Connection B.
Thu, 01/12/2017 - 10:15am

I think anyone who has health insurance, whether or not it is through the ACA, is concerned about rising premiums, higher deductibles and co-pays, caps on coverage, and insurance, rather than doctor, dictated treatment. Even those with employer-provided health care are often sacrificing raises or other benefits because employer costs rise significantly year after year. This has been true for at least the last 20 years. I agree with the comments by Robert Graboyes that "even Republican solutions are focused largely on how bills are paid - through insurance - rather than how bills are comprised. And as long as all we talk about is insurance and the demand side we're not going to get out of it." Health care costs need to be addressed by the legislature, not dictated by insurance companies. As a traveler, I have met many people who fly to other countries for medical care because the cost is as much as 75% cheaper than in the U.S. The people I have talked to have been quite happy with their treatment and would do it again. If it can be done elsewhere for that much cheaper, why not here?

Thu, 01/12/2017 - 1:19pm

How many of those countries you have gone to have a health insurance system like we do here in U.S.? Many countries have universal health care systems. Our country doesn't seem to look at health care as a human right.

David Richards
Thu, 01/12/2017 - 11:47am

Don't expect your health insurance costs per month to do anything but go up regardless of any repeal of the ACA. Costs have been going up higher than inflation for decades, and the Republicans have suggested nothing that would change that.

Thu, 01/12/2017 - 4:49pm

Good question. It could be done here but the GOP has blocked every attempt to fix our broken system. ACA had provisions to eliminate many treatments that did not benefit patients but benefited hospitals and doctors. The GOP called it 'death panels' (wasn't) and that was that. Single payer would work here but the GOP won't even discuss that - not even discuss it.

Thu, 01/12/2017 - 4:51pm

Well said.

Kevin Grand
Thu, 01/12/2017 - 10:17am

<i>"If you like your plan you can keep it."</i><i>"If you like your doctor, you can keep them."</i><i>"Americans will see a savings of $2,500 after the ACA is implemented."</i>Considering that these are all lies told to the American People (the cost for my family have spiked to over $1,000/month), and the method in which it was implemented, the sooner that Congress and President Trump can scrap this train wreck, then better!

Carol Waltman
Thu, 01/12/2017 - 11:08am

Repeal is essential, and there are several viable ways to replace. If you don't know what they are, do the research... they're not hard to locate. Pick the best one and do it very soon. Fear mongering is unnecessary and detrimental to fixing the current mess.

John Q.
Thu, 01/12/2017 - 11:54am

A "viable alternative" is a plan that can get the support of Congress, the incoming President and doesn't throw millions off of their current health insurance. So far, there's no sign of a "viable alternative". Perhaps that's why you don't actually share any of them because they don't exist.

Fred Ziffel
Thu, 01/12/2017 - 12:43pm

Tim Walberg wants "a stable transition to patient-centered health care solutions that give families more choices and lower costs." Wow, so do I! I want more choices and lower costs, too. The problem is, reality. I want sunshine and rainbows and my very own pony, too. Reality says I can't have those things, no matter how badly I want them. People who ignore reality eventually get slapped in the face by it.

Thu, 01/12/2017 - 5:19pm

Carol, will you please refer me to a website where I read in detail the Republican plan to replace the ACA

Doug Andridge
Thu, 01/12/2017 - 9:40pm

Joan, Are you still waiting for Carol's Response. Hope you are not holding your breath.

Fri, 01/13/2017 - 10:14am

Doug, breath-holding probaly would have the same outcome as ACA repeal will have for many of our fellow Michiganians. Not good for our life expectancy.

Kenneth Kolk
Sun, 01/15/2017 - 2:08pm

Tim, as usual, is blowing smoke to cover how radically reactionary his ideas are. Tim's ideas of "patient centered" health care would include banning all abortions, the "morning after pill, and contraceptives. Tim is a leader in the Republican push to change Medicare into a voucher system that will only pay part of cost of the basic Medicare. Guess who will get stuck with the rest. Tim truly represents the branch of the GOP that believes that America's best advice to the ill and old is "Die Quickly!"

Kevin Grand
Thu, 01/12/2017 - 7:14pm

Considering the fact that health insurance companies would lose a captive audience after the repeal of the ACA, to say nothing about what would happen when the replacement plans that I've seen which will be introducing more competition (i.e. purchase over state lines), the cost curve cannot do anything <b>but</b> get bent downwards.

Thu, 03/16/2017 - 9:27am

Paul Ryan was very clear that insurance over state lines is not in the new Trumpcare plan, because these changes are proposed through budget reconciliation. Thus, they are just defunding anything they don't like about the current ACA. Insurance over state lines would require new legislation.

This again is just redistribution of wealth to the rich, who have seen the highest increase in wealth in the last decade. How much money is enough for you?

Thu, 01/12/2017 - 1:19pm

Recall the "public option"? That got defeated by THE REPUBLICANS, most likely cuz their C_O buddies in the FOR PROFIT healthcare INDUSTRY "earn"(???) ... all of them. . . over $10,000,000 (that's TEN MILLION DOLLARS) per year ****each****. So, natch, they didn't want their income dropped, so NO PUBLIC OPTION!!!!!!!!!!!!!!!!!!!!!THAT'S WHY!!!!!!!!!!!!!!!!!

Rick A. Gardner
Sat, 01/14/2017 - 4:59pm

The over inflated salaries are just the tip of the ice berg. Health Insurance companies fork over $19 billion dollars a year of our premiums to their Wall Street Shareholders. They also pay their Corporate Lawyers billions of dollars a year so they can lobby Congress, and so they can swindle us out of our benefits by using legal loop holes hidden in the 10 of thousands of pages of health care laws. The whole system is a scam!

Thu, 01/12/2017 - 1:25pm

It is not the ACA that made your insurance premiums go up. It is the insurance companies.

Thu, 01/12/2017 - 8:29pm

The ACA made it possible for them to do so. Supply and demand no longer existed. They were legislated a large customer base.

Fri, 01/20/2017 - 11:59pm

Supply and demand has never existed for healthcare. Insurance is a bad model for healthcare in general. In an insurance model, you're betting against the insurance company that a certain outcome wont be reached. That works for flood insurance. But EVERYONE will need to access the healthcare system at some point in their lifetime. Which means that the only function that an insurance company performs is being a middleman that raises overall costs in order to fit themselves in the system to make a profit.The whole insurance model of healthcare has to go.

david waymire
Thu, 01/12/2017 - 1:30pm

Kevin, I would be interested in seeing a copy of your policy before including the rates and a copy of your policy now, including the rates. I would expect that you are self-employed, and therefore involved in the individual market. You were probably buying a very skinny policy that provided no mental health benefits, no maternity coverage, limited prescription access, an a very real change at bankruptcy if you ran up $100,000 in bills, which is a good start if you have a heart attack or cancer. Your new policy covers a variety of important essential services, and has a limit on how much you would ever pay for a health event, protecting you from bankruptcy.

Kevin Grand
Thu, 01/12/2017 - 7:47pm

Exactly what makes you think that I am anywhere even <b>remotely</b> interested in covering those items (i.e. mental health or maternity coverage).It's thinking that I want coverage for certain items because <i>you</i> think that I want to those items, which is one of the major driving factors of why the ACA is collapsing like a house of cards.ACA supporters should be honest with everyone here regarding one indisputable and undeniable fact: The ACA was set-up solely as a mechanism to transfer wealth from one segment of the population to another.Don't take my word on this.Check out the comments from the \'93Obamacare architect\'94 <a href=" rel="nofollow">Jonathan Gruber himself</a> when he was talking about how \'93the stupidity of the American voter\'94 helped to make the ACA a reality. Honestly, I'm a little surprised that Mr. Wilkinson or Ms.Derringer had not included that detail in this piece.

Tom Hicks
Thu, 01/12/2017 - 8:13pm

Just curious Kevin. Would you support a Medicare type coverage for everyone? Pay a little higher taxes probably but whether you pay taxes or insurance premiums there really isn't much difference.

Kevin Grand
Fri, 01/13/2017 - 1:04pm

Actually, Tom, I would like to see people paying for their own health care and not attempt to lay claim to what has been earned by others.There really isn't any difference between someone shoving a gun in my face and demanding my wallet, and someone cajoling a politician to use the force of government to do the same.Regardless of their rationale behind it.

David Waymire
Fri, 01/13/2017 - 10:34am

I thought you would be unable to see the value of mental health care. :-)Just to be sure, if conservative Chris Christie gets his way, you will be covering six months of drug rehab. And if everyone doesn't support, say, maternity leave, then you will find the cost of insurance for those who do need it getting higher and young families being unable to pay for the one procedure EVERYONE goes through in life. i

Kevin Grand
Fri, 01/13/2017 - 12:58pm

And exactly how did Americans ever pay for their own health care before the insurance industry came along and people were clamoring for <b>others</b> to pay for their own insurance?God given rights are specifically mentioned in the early documents from the beginning of the Republic.Material rights, such as the "right" to health care, are not.

Mitch Jones
Fri, 01/13/2017 - 12:32am

And don't forget Nancy's, "Pass the bill and we can see what's in it."

Kevin Grand
Fri, 01/13/2017 - 1:09pm

The "stupidity of the American voter" comment made by Jonathan Gruber himself drives the point home on the arrogance of ACA proponents far more than Former Speaker Pelosi's inane statement.

Teri Ercolani
Fri, 01/13/2017 - 1:42pm

I have to agree! We are a small business owner prior to ACA we were paying a premium of 1797.00 and our company was allowed to pay for the health plan Now we are paying 2527.00 a month for health care with a 18,000 deductible. Out of our own pocket. "Keep your plan" not so! Big big lie!! Our original plan we had for 15 years was scrapped! Thanks to Obamacare!

Sun, 01/15/2017 - 2:26pm

I wonder if you'll be heard from in about 2-3 years when you have no insurance (a huge deductible and no preventive coverage at all).But hey - that's what you wanted and you get what you wanted.

Richard Boothman
Thu, 01/12/2017 - 10:19am

The truth of the Obamacare repealers' efforts that never get seems to get reported is that we ALL pay for the uninsured - we pay unnecessarily, insanely and dearly - when our hospitals are unavoidably required to take care of uninsured patients who, in the absence of insurance, delay needed elective care until they are in dire straits, appearing in emergency rooms for the most expensive care of all, with greater, more significant, incredibly more expensive, and heart rending social consequences. That care and the social consequences that follow aren't free! We all pay for it - not as dearly of course, as the patients and their families who are left with little social and medical options, but like it or not, Republican or Democrat, we're all in this together . . . and we ALL pay.

Carol Waltman
Thu, 01/12/2017 - 11:10am

No one needs to be punished for voting against Obamacare. A viable alternative plan is waiting to be utilized. No fear mongering!

Rick A. Gardner
Sat, 01/14/2017 - 5:40pm

What do you think of this? A single system such as Medicare that is partially or fully funded with a federal sales tax on everything including a reduced rate for food, say 1%. Then everyone would pay for health care including the unemployed, disabled, uninsured, foreign travelers, and even illegal immigrants. This would also be affordable for small business.

Mary Peterson
Thu, 01/12/2017 - 11:23am

Seeing is believing. Given that the Repubs have had 6 years to get their plan in place, don't you think we should already know the details?

Lola Johnson
Thu, 01/12/2017 - 6:07pm

I have not heard of any viable plan. "Selling over state lines" is a license for every company to base itself in Texas or some other Southern state that has no insurance laws and let them just plain rob everybody. The other cure-all is usually "tort reform", which means any fly-by-night outfit can kill you or your child and you cannot sue for anything other than actual medical costs. Rip-offs, rip-offs. We no longer will fall for this specious crap. Safe, affordable preventive care and treatment for every American is the only thing that is now acceptable.

Steve Manor
Thu, 01/12/2017 - 10:59am

It appears that, except for Gennese and Wayne Counties, the bulk of the loss resulting from the repeal of the Affordable Care Act will fall on the people in the northern lower and upper peninsulas. And most of those folks voted for repeal, i.e., Republican. So repeal it. HOWEVER, Congress should also repeal the laws that require medical providers to provide services to the uninsured/underinsured or without large cash reserves. Otherwise, rather than ALL of us sharing in the cost of providing service, only those of us with insurance will be paying for the uninsured. Before the ACA I'm familiar with people who had a lot of resources but carried no insurance. These people simply went to the emergency room when they were very sick, got treatment and refused to pay. The Hospital passes that cost on to those who have insurance and can pay. I resent that. They're leeches! So pass ALL the appropriate laws and let those who don't want the ACA go it alone! I will feel appropriately sorry for them, but lessons need to be learned.

Fri, 01/13/2017 - 1:14pm

I don't have health insurance, but do have coverage through and health care coverage company based out of Ohio. My coverage isn't as extensive as the ACA (i.e. doesn't cover flu shots, birth control, ....) and not open to smokers, but for an individual I only pay $85 a month (they have a cheaper and a more expensive option). You have to wait one year for coverage to cover pre-existing conditions. Their coverage crosses state lines and tell you to negotiate for lower costs and give health tips in newsletters they send out. I made sure the Better Business Bureau gave them a good rating before I signed up. Tax software makes it hard to select the correct option for selecting them, so I am hoping it is repealed so I don't have to worry about it. They are faith based (send out prayer list of people requesting prayers), occasionally I send a note of encouragement to someone. Job hunting, so I like having something that stays with me if I move to another part of the country. Obamacare is bad because if you signup for it you basically as giving up hope for getting a better income, because if your income goes up later in the year you need pay a steep higher amount, since you lose your government subsidy. I also looked at a healthcare coverage company based out of Florida, but decided to pick a company that has a headquarters based closer to my current location.

Thu, 01/12/2017 - 12:58pm

So your solution is to let those with no insurance die?Wow! I hope you don't call yourself a Christian, because Jesus would be disgusted with you.

Thu, 01/12/2017 - 11:25am

Why are you making this out to be a problem? Nobody has any intention of cutting people out of their healthcare....but Obamacare is a mess and needs to be fixed one way or another.

John Q.
Thu, 01/12/2017 - 11:52am

With all due respect David Maxwell, when your proposed plan doesn't provide coverage for millions who have insurance coverage today, that's a problem. Your claim that there's no intent to cut people out of their coverage isn't supported by the outcomes of what is being proposed.

Thu, 01/12/2017 - 11:38am

Tip . . . when you make a map/chart like yours, also color code the legend. Mine show no color to make sense of the map. Could be me though.

Mike Wilkinson
Thu, 01/12/2017 - 1:29pm

George, The map's legend is color coded. It may be your web browser. I'm using Chrome and it works. Thanks for reading.

Thu, 01/12/2017 - 11:42am

Costs will go up once it's repealed

Thu, 01/12/2017 - 11:49am

Obamacare did nothing to address healthcare cost, and everything to count the number of people insured. It did not matter that the deductibles and co-pays are becoming so high that the insurance is next to useless. When more than 20 other countries have lower healthcare costs and better results than the U.S., it is time to rip up the current system and start anew. There are many good ideas from other countries. It is time to benchmark and select the best ideas. Of course we as citizens bear the burden to do our part. Our diet may not be as good as those in other countries. We may be too used to asking for medical procedures with no thought to what the cost is since insurance covers it. And yes, there is some small part caused by waste, fraud, and abuse among patients and providers. Time to make people understand that that is unacceptable.

Sue S
Thu, 01/12/2017 - 1:27pm

Rich, not sure what you are proposing, but I agree with you. In countries other than the US the healthcare system is not-for-profit, unlike the US where hospitals and all affiliated medical treatment facilities are in business to MAKE A PROFIT. They have shareholders or are owned by large corporations. Other civilized countries have Medicare systems of coverage for all, paid for by taxes. The healthcare lobby is strong, and between pharmaceuticals/health products &amp; insurance industry have spent nearly $6 billion on lobbying efforts. They are the top 2 spenders since 1998 in the link below. You can then drop down the list of the link below to pick up hospitals/nursing homes, health professionals to get another nearly $3 billion.'d pay more in taxes to not have to pay for healthcare. I'm sure my employer would as well. I'm willing to pay more for Social Security and Medicare too........things aren't free and the ongoing assault of "lower taxes" is creating a society that can't survive except for the top percentages who pay less in taxes as a percentage than I do. But I didn't vote for the party that wants these policies. I never do.

Rick A. Gardner
Sat, 01/14/2017 - 6:06pm

The last time I check on world health care costs it was showing that the U.S. is spending 19% of our GDP on health care, whereas the rest of the world spends between 7% to 12% of their GDP on health care. We are rated 39th out of 195 countries for quality of health care by WHO. [World Health Organization] I will venture a guess that if we were to eliminate the top 20% of the income earners in this country from these figures we would be near the bottom of the list of 195 countries. We have the best health care that money can buy, but most of us can't afford it.

Thu, 03/16/2017 - 9:45am

I have quoted the same statistics, and people don't seem to understand this. Our current system only thrives if people remain sick. Our current system has created a society of unempowered, codependent citizens. I would respectfully disagree that we have the best healthcare money can buy, because the US population as a whole is very unhealthy (obesity, diabetes, heart disease, addictions).

Japan has the healthiest population and the least per capita cost in healthcare, and their life expectancy continues to rise.

Thu, 01/12/2017 - 12:50pm

My question is does the %11 this will effect care??? This scary story means nothing if this %11 are okay with it.. Which I have a feeling might be..

Thu, 01/12/2017 - 1:16pm

Some of the elephants in the room: I've heard Republicans such as Ryan say for years they have a better where is it?No option except plans whose CEO's and other staff make millions in salary per year plus benefits, stock options. No skin in the game. They need to be Trump he loves to do to car co.execs!Restrictions on pharmaceuticals from Bush and Thompson. Can't order from other countries e.g. Canada. Legislated no negotiating prices for groups, Medicare. I think big pharma wrote that bill.BTW if you think your costs have recently gone up d/t ACA, you've been paying thru your taxes for years. Look up the Hill-Burton act 1946. ER's have been providing care thru mandate for years. People who had no money or doctor used them for the most basic care at high cost to us all.I'm a nurse, I want people to get care..acute and preventive. It's healthy for all. Germs, diseases don't have political affiliations.

Cheri Clifton
Thu, 01/12/2017 - 1:20pm

Before Obamacare my husband was uninsurable because of his preexisting conditions. One of his prescriptions is $18000.00 per month and our income is just above poverty level so Medicaid was/is not applicable. I was able to purchase catastrophic medical insurance for myself at $880 per month and it had a deductible of $11,000 deductible. Without Obamacare we were out of luck. With Obamacare we pay a little over $300 per month for a good plan, a Bcbsm silver plan that has been an amazing life saver. Without insurance we will be in dire straits once again. It is hard not to worry about what will happen now that trump will take office but I have a sick feeling we are in trouble.

Thu, 01/12/2017 - 1:20pm

We need to do everything we can to make sure that the insurance companies get to keep their huge salaries. Seems like the millions of dollars they make is not enough. And remember they are financing our politician's elections. Don't ya love greed?

Fri, 01/13/2017 - 4:21am

Great points. But wheres the part where my insurance went from $303 (policy canceled by ACA) to $557, just shy of my mortgage payment?. And the part where my old Bcbs policy had a deductible of $2000 but paid 80/20 until the deductible was met. With ACA my $2000 deductible is now up front, as in they pay ZERO until i pay 2k. So my last MRI under my $303 policy cost me roughly $200. The one my doctor wants me to get now will cost me over $1000. Needless to say, that MRI isnt getting scheduled soon. I wouldn't mind paying the $557 a month to help someone out, if I COULD ACTUALLY AFFORD TO USE MY INSURANCE.

Thu, 01/12/2017 - 1:45pm

HHS Home - Impact of the Affordable Care Act in MichiganImpact of the Affordable Care Act in Michigan (Dec. 3, 2016)Hundreds of thousands of Michiganians have gained coverage, and millions more have had their coverage substantially improvedToday, the U.S. Department of Health and Human Services released an extensive compilation of state-level data illustrating the substantial improvements in health care for all Americans over the last six years. The data show that the uninsured rate in Michigan has fallen by 51 percent since the Affordable Care Act (ACA) was enacted in 2010, translating into 618,000 Michiganians gaining coverage. And, in addition to residents who would otherwise be uninsured, millions more Michiganians with employer, Medicaid, individual market, or Medicare coverage have also benefited from new protections as a result of the law.\'93As our nation debates changes to the health care system, it\'92s important to take stock of where we are today compared to where we were before the Affordable Care Act,\'94 said Secretary Sylvia M. Burwell. \'93Whether Michiganians get coverage through an employer, Medicaid, the individual market, or Medicare, they have better health coverage and care today as a result of the ACA. Millions of Americans with all types of coverage have a stake in the future of health reform. We need to build on our progress and continue to improve health care access, quality, and affordability, not move our system backward.\'94Highlights of today\'92s data release include:Employer Coverage: 5,876,000 people in Michigan are covered through employer-sponsored health plans. Since the ACA was enacted in 2010, this group has seen:\'95An end to annual and lifetime limits: Before the ACA, 3,547,000 Michiganians with employer or individual market coverage had a lifetime limit on their insurance policy. That meant their coverage could end exactly when they needed it most. The ACA prohibits annual and lifetime limits on policies, so all Michiganians with employer plans now have coverage that\'92s there when they need it.\'95Young adults covered until age 26: An estimated 73,000 young adults in Michigan have benefited from the ACA provision that allows kids to stay on their parents\'92 health insurance up to age 26.\'95Free preventive care: Under the ACA, health plans must cover preventive services \'97 like flu shots, cancer screenings, contraception, and mammograms \'96 at no extra cost to consumers. This provision benefits 4,543,547 people in Michigan, most of whom have employer coverage.\'95Slower premium growth: The average premium for Michigan families with employer coverage grew 3.5 percent per year from 2010-2015, compared with 6.8 percent over the previous decade. Assuming Michigan premiums grew in line with the national average in 2016, family premiums in Michigan are $3,300 lower today than if growth had matched the pre-ACA decade.\'95Better value through the 80/20 rule: Because of the ACA, health insurance companies must spend at least 80 cents of each premium dollar on health care or care improvements, rather than administrative costs like salaries or marketing, or else give consumers a refund. Michiganians with employer coverage have received $63,103,476 in insurance refunds since 2012.Medicaid: 2,300,958 people in Michigan are covered by Medicaid or the Children\'92s Health Insurance Program, including 941,328 children and 252,704 seniors and people with disabilities covered by both Medicaid and Medicare. The ACA expanded Medicaid eligibility and strengthened the program for those already eligible.\'95181,000 Michiganians have gained coverage through Medicaid: An estimated 181,000 Michiganians have health insurance today because Michigan expanded Medicaid under the ACA. Coverage improves access to care, financial security, and health, resulting in an estimated 21,000 more Michiganians getting all needed care, 25,800 fewer Michiganians struggling to pay medical bills, and 220 avoided deaths each year.\'95Thousands of Michiganians with a mental illness or substance use disorder are getting care: Thanks to expansion and improved access to treatment, an estimated 17,000 fewer Michiganians are experiencing symptoms of depression.\'95Michigan is saving millions in uncompensated care costs: Instead of spending $190 million on uncompensated care, which increases costs for everyone, Michigan is getting $1 billion in federal support to provide low-income adults with much needed coverage.\'95Children, people with disabilities, and seniors can more easily access Medicaid coverage: The ACA streamlined Medicaid eligibility processes, eliminating hurdles so that vulnerable Michiganians could more easily access and maintain coverage.\'95Michigan can better fight opioids: Under the ACA, CMS provided technical assistance that is giving Michigan the opportunity to strengthen Medicaid services for people struggling with opioid abuse or other substance use disorders (SUDs). For example, Michigan received support to: better identify individuals with an SUD; expand coverage for effective SUD treatment; enhance SUD care delivered to beneficiaries; and develop payment mechanisms for SUD services that incentivize better outcomes Individual market: 313,123 people in Michigan have coverage through the Marketplace. Individual market coverage is dramatically better compared to before the ACA:\'95No discrimination based on pre-existing conditions: Up to 4,394,173 people in Michigan have a pre-existing health condition. Before the ACA, these Michiganians could have been denied coverage or charged an exorbitant price if they needed individual market coverage. Now, health insurance companies cannot refuse coverage or charge people more because of pre-existing conditions.\'95Tax credits available to help pay for coverage: Before the ACA, only those with employer coverage generally got tax benefits to help pay for health insurance. Now, 275,080 moderate- and middle-income Michiganians receive tax credits averaging $233 per month to help them get covered through\'95Women pay the same as men: Before the ACA, women were often charged more than men just because of their gender. That is now illegal thanks to the ACA, protecting roughly half the people of Michigan.\'95Greater transparency and choice: Before the ACA, it was virtually impossible for consumers to effectively compare insurance plan prices and shop for the best value. Under the ACA, Michigan has received $10 million in federal funding to provide a more transparent marketplace where consumers can easily compare plans, choosing among 62 plans on average.Medicare: 1,947,787 people in Michigan are covered by Medicare. The ACA strengthened the Medicare Trust Fund, extending its life by over a decade. In addition, Medicare enrollees have benefited from:\'95Lower costs for prescription drugs: Because the ACA is closing the prescription drug donut hole, 212,075 Michigan seniors are saving $249 million on drugs in 2015, an average of $1,176 per beneficiary.\'95Free preventive services: The ACA added coverage of an annual wellness visit and eliminated cost-sharing for recommended preventive services such as cancer screenings. In 2015, 949,718 Michigan seniors, or 74 percent of all Michigan seniors enrolled in Medicare Part B, took advantage of at least one free preventive service.\'95Fewer hospital mistakes: The ACA introduced new incentives for hospitals to avoid preventable patient harms and avoidable readmissions. Hospital readmissions for Michigan Medicare beneficiaries dropped 3 percent between 2010 and 2015, which translates into 1,767 times Michigan Medicare beneficiaries avoided an unnecessary return to the hospital in 2015. \'95More coordinated care: The ACA encouraged groups of doctors, hospitals, and other health care providers to come together to provide coordinated high-quality care to the Medicare patients they serve. 25 Accountable Care Organizations (ACOs) in Michigan now offer Medicare beneficiaries the opportunity to receive higher quality, more coordinated care.

Rick A. Gardner
Sat, 01/14/2017 - 6:39pm

These are great points in your post. Now lets simplify all of this. We have 55.5 million Medicare recipients in this country and 73.8 million Medicaid recipients. This is 129,300,000 of the 325,000,000 people in this country. Since CMS [Centers for Medicare and Medicaid] are insuring nearly half of the country, why don't we expand coverage to everyone and write a health care bill that says, "if you go to a doctor or any medical facility you are covered. Remit all bills to CMS for payment." [1] Why do we need different policies that provide different coverage? [2] Why do we need thousands of pages of legislation to go to a doctor? [3] Why isn't everyone covered with the same standard of health care? [4] Why don't we just go with a single system such as the already established CMS and pass a federal sales tax for funding. A sales tax would require everyone to pay for health care, and everyone would be covered.

Thu, 01/12/2017 - 2:50pm

Susan, you touched on a huge point in all of this. The insurance companies and Big Pharma helped write the ACA. Who were they looking out for? Not me or you! Their profits and exec's salaries are obscene, if there is one thing in this country that NEEDS to be regulated it's Healthcare insurance and big Pharmaceutical. The ACA is 2700 pages long with over 20,000 pages of regulations concerning the ACA, absolutely out of control. There are good parts to the ACA which I believe will stay no matter what, the other 2690 pages need to go. The fear mongers are out in full force right now saying 20 million will lose their insurance, really? How many of them have insurance because it is required by the ACA. I do not believe for one minute there will be a repeal without a replacement ready to go.

Thu, 01/12/2017 - 6:58pm

I don't know why you wouldn't believe it, since it's happening right in front of our eyes.

Thu, 01/12/2017 - 3:11pm

Those who are not using the ACA do not understand the good it's doing. As the mother of two children with pre-existing conditions who will be severely harmed by the repeal of the ACA, I cannot tolerate ANYONE who says it should go before something at least as good is in place. Repealing this law will kill people (I am NOT fear mongering, this is my childrens life) or cause great detriment to their welfare. Without the ACA, my children would have hundreds of thousands of dollars in debt because insurance companies could refuse to insure them. They happily pay the outrageous (yes we agree on that) premiums because they overjoyed to have healthcare. Anyone who thinks the ACA should be repealed without considering these circumstances is utterly inhumane.

Thu, 01/12/2017 - 3:23pm

I'd be interested to know the statistics for Michigan residents who lost (i.e. refused to buy because of high costs) insurance at the onset of the ACA. If someone can point me to a resource for this I'd be appreciative.

Lola Johnson
Thu, 01/12/2017 - 6:18pm

The ACA subsidizes premiums for those who can't afford them. Not for those who just don't want to, but prefer to force taxpayers to cover their care through indigent care, increased charges for those who do have insurance and by declaring bankruptcies. If you do not have employer-provided insurance, don't qualify for healthy Michigan, and must pay more than 8% of your income for premiums, there is a subsidy for you, unless you earn more than $80,000/year. If you earn a good living and still don't want to pay your own way through life, there is a fine. Sucks to be poor, rich you, I guess.

tom adams
Thu, 01/12/2017 - 7:42pm

If they had'nt let the insurance companies write the law we wouldn't be in this mess, it would work for everybody !!

Rick A. Gardner
Sat, 01/14/2017 - 4:32pm

More Choices??? How many choices do you need to go to a doctor for an illness, injury, or disease? The mentality of our elected officials never ceases to amaze me. I get sick to my stomach listening to these educated idiots with their choices about health care, How many choices do you need to go to a doctor for a broken arm of leg? We don't need any choices, all we need is a health care system that covers "everything." Furthermore, since our highly talented elected officials can't figure out what to do about our health care system, I will simplify it for them. [1] We go to a doctor or medical facility for treatment. [2] We receive our treatment. [3] The doctor or medical facility remits the bill for payment, [I.E. They send the bill to Medicare, Medicaid, or an Insurance Company] Now, is that all that difficult? Why does our elected officials have so much trouble paying a medical bill?

Doug Andridge
Thu, 01/12/2017 - 9:31pm

You are spot on Tom.

Doug Andridge
Thu, 01/12/2017 - 9:30pm

I as I have said before. Trump voters were duped. They hate to hear it but facts are facts. You were duped.

Big Fish
Sun, 01/15/2017 - 10:18am

Here's the best one pager on this mess of a H/C system: the last line : "Nobel Prize winner Angus Deaton stated clearly what is wrong. The American health care system \'93seems optimally designed for rent seeking and very poorly designed to improve people\'92s health.\'94 And nothing is going to get better until we tackle that problem head on."

Fri, 01/13/2017 - 7:57am

Why only list percentages?This article would be much less of a propaganda piece if it listed actual numbers. As if 13.1% of Emmet County is remotely comparable to 12.7% of Wayne County.This article is a prime example of how the media uses deliberately selected statistics to "prove" their pre-established opinion.Figures don't lie, but liars figure, is totally appropriate for this opinion piece.

Sun, 01/15/2017 - 11:49am

Interesting that if you overlay a map by congressional district that voted for Thrump, it shows that those who voted for Thrump (or didn't vote at all) are most at risk of losing ACA benefits. Is it possible for the Bridge to post a graphic of this?DD

David Zeman
Fri, 01/13/2017 - 10:55am

Don, Thank you very much for your opinion piece. What Bridge's reporting shows are facts, not opinions. And that includes the raw numbers that you say the package lacks. If you click on any county on our map you will see the percentages of residents who get the ACA, Medicaid expansion and traditional Medicaid, along with the raw numbers for each. I'm not sure what else we could have done to give readers a straightforward snapshot of the people impacted in every county across the state. Would love to hear what you see in this article that constitutes editorial opinion. The writers do not pass judgment on the pros or cons of the Affordable Care Act, nor do they suggest in their writing whether retention, repeal, replacement or come combination thereof is the right way to turn. The basic point that this article makes is that repeal without replacement will bring uncertainty to a wide swath of residents across many parts of the state, which is undoubtedly true, whatever you think of Obamacare and whatever your political perspective. David ZemanBridge Editor

Kevin Grand
Sat, 01/14/2017 - 8:45am

Mr. Zeman,While I'm not jumping in the opinion v. fact debate regarding this article, there is one point that even The Bridge cannot refute: Exactly what difference would it make if the ACA were repealed by President Trump <a href=" rel="nofollow">or the ACA were to collapse due to its own built-in instability?</a>The end result would still be the same in either scenario, Mr. Zeman.

Fri, 01/13/2017 - 8:22am

Our medical system is based on two problematic ideas, the consumer/patient should have any and every treatment they desire and someone else should pay their bill with no distinction in care. Health care companies like this and will fill the demand and voters/workers like it as long as it's added to the deficit/federal debt/ or their employers expense column. This is incentive hell. Without addressing these basics we are doomed. The ACA doesn't touch these problems, Will any other plan? I doubt it.

Jack M.
Mon, 01/16/2017 - 2:06am

Does Anyone Really Expect Politicians To Fix This Mess?They Have Their Health Care Paid For By US...For Life.I Have Benefited From The Healthy MI Plan.My...Question IS....Why Can't They Be Put On Their Own POLICY?We as Taxpayers Could Use The Savings To Help Those Who are Less Fortunate...Instead Of Paying The Politicians HEALTH Care For Life.

Keith D Cameron
Fri, 01/13/2017 - 9:29am

The ACA was ridiculous for me. I had a great 'Child only' plan that cost me $58.00 a month on a kid that's never had or needed anything other than check-ups and immunizations (She's a healthy kid). My Monthly premium went up by 600% the first year of the ACA. My Deductible went from $1,000 to $5,000. Now I'm not sure what kind of spastic dreamland you have to live in to considered that "Affordable" but I sure wish I could have kept the plan I had and loved and was affordable.I don't know what the Republican reboot of Heathcare will be, but it can't be worse than what I had force fed to me under the ACA.

Mon, 01/16/2017 - 10:41am

These people who voted for Trump and are dependent on the social Democratic welfare state for basic needs like health insurance, food assistance, section 8 housing, disability, supplemental security income,\'85 well, they are in for a big surprise when that Safety net is dismantled by the Republican machine that wants to deregulate banks, rape our environment for profit. But no worries, there will be plenty of employment opportunities in the fast food, temp services, and hotel-motel tourist industry. But you better not get sick...environment for profit. But no worries, there will be plenty of employment opportunities in the fast food, temp services, and hotel-motel tourist industry. But you better not get sick...

David Waymire
Fri, 01/13/2017 - 10:36am

Hope that kid stays healthy. Because if will be asking for donations at the local gas station, like we used to see all the time for kids with cancer, lost of a limb, head injury after playground accident, etc. You are betting on a good outcome. Betting is the key word here.

Debra Navarro
Fri, 01/13/2017 - 2:32pm

The problem with Obamacare is that it was left in the hands of for profit insurance companies. When you think of the number of people who live in the U.S. , if everyone paid a lousy 10 dollars a month we could afford to treat everyone who is sick. I'm not saying we could cover things like elective surgeries but legit illnesses could be.I'm pretty sure all Americans would be happy to pay that much. Of course you would have to also get the drug companies under control too.

Mon, 01/16/2017 - 12:39pm

There is no accountability held for healthcare/pharmaceutical companies. Therefore Doctors, facilities (rehab, nursing home) Pharmaceutical) medication and durable medical equipment) are priced at whatever they want, insurance companies decide what there. Ask reimbursement is going to be, so they pay and then the balance from deductible, copay or and out of pocket goes to patients. AmericaOnce the riches and free country can't take care of our own people old, young, sick and mental but we are keep taking in more?

Fri, 01/13/2017 - 8:36pm

$10 a month?? You must be Berning something.

Rick A. Gardner
Sat, 01/14/2017 - 4:36pm

How about a Single System with a Federal Sales Tax on Everything? Then everyone pays, and everyone is covered.

Kevin Grand
Sun, 01/15/2017 - 9:35am

That's an easy question to answer Mr. Gardner, no one in their right mind should ever want it <a href=" rel="nofollow">because single payer cannot work</a>.Contrary to what you may have heard from ACA (or single payer) proponents, people will eventually have to pay something for their healthcare, so ultimately, it's back to square one.

Mark Whelan
Mon, 01/16/2017 - 1:08pm

I find it very interesting that you do not mention that many of the 345,000 people you quote as having bought ACA insurance policies were forced to by the law because their policies were cancelled even though the President said dozens of times this would never be the case. He even admitted to purposefully lying about it as did the architects of the plan.. Most if not all of these people ended up paying many thousands more for less coverage and vastly higher deductibles. The Democratic leaders also agree that the ACA is flawed and broken and have known it from the beginning but did nothing when they controlled the House and Senate to fix it. They even now have no suggestions for how to fix it, just condemnation because "CHANGE IS COMING" and they do not like it.

Tue, 01/17/2017 - 3:01pm

The article says people may be temporarily without healthcare insurance when ACA is repealed. That is completely FALSE. There will be a transition period (probably until at least 2018) where you will still have your old coverage, until your new coverage begins.

Tue, 01/17/2017 - 10:45pm

If you're thinking that repeal of the Affordable Care Act (AKA Obamacare) doesn't affect you or maybe that it will be better to just start over from scratch, you might want to think about what you--yes, you!--have to lose. Just a reminder that even if you are "safely" ensconced behind employer-provided insurance, the protections set forth in the ACA apply to you, too--and if those protections are repealed along with the rest (or any part) of the program, you will also be affected. That means you may be trapped in a job, because your pre-existing condition may mean you will not qualify for new insurance offered by another employer, and the cost of private insurance would be prohibitive. If your employer shuts down, lays you off, or even changes insurers, well, you are out of luck. (The Senate GOP voted this week that they would not require an eventual ACA replacement to protect against discrimination for pre-existing conditions, which was the standard before the ACA.) It means that you (a young adult under the age of 26) or your adult children (over 18) may find yourselves without the protection of insurance, as the Senate GOP voted last night that an eventual ACA replacement will not be required to allow young people to remain on their parents' insurance up to the age of 26. It means that if you have a high-risk pregnancy, or life-threatening illness such as cancer, you may not be able to afford all the care you need, because you may hit lifetime or annual caps. If you have an infant born with any kind of severe medical condition, or premature, they may hit their lifetime insurance cap before they are old enough to walk. The Senate GOP voted last night that an eventual ACA replacement program would not be required to prohibit lifetime insurance caps. It means that if you are a struggling parent who is un- or underinsured, you will no longer be able to count on at least your kids getting the routine medical and dental care they need under the Children's Health Insurance Plan (CHIP). The Senate GOP voted that CHIP is not required to be protected by an eventual ACA replacement. These provisions of the ACA affect everyone in this country, not just those without insurance through their employers. If you are not okay with these changes, call your representatives and let them know what's important to you. Nothing has been set in stone yet, but our legislators have shown us a map of what they plan to do if constituents don't make their voices heard loud and clear.

Tue, 01/24/2017 - 6:45am

I for one do not want single payer. If you want single payer be prepared to see half or more of your paycheck go to taxes to fund it. All the countries that have it have extremely high taxes.