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Health care in rural Michigan communities suffering, despite Obamacare

In 2010, an estimated 1.2 million Michigan residents had no health insurance. By 2016, that fell to approximately 527,000. That’s primarily because the Affordable Care Act provided health care to nearly one million Michigan residents, either through expansion of Medicaid for low-income recipients or the federal individual marketplace for those who don’t qualify for Medicare, Medicaid or insurance through an employer.

But, as of this writing in early 2018, the future of health care is unclear. Congress in December repealed a pillar of Obamacare – the tax penalty on individuals who fail to get insurance. Experts say that will lead to higher premiums, destabilize the individual marketplace while the Congressional Budget Office estimated it would leave 13 million fewer Americans with health insurance.

The Uninsured in Michigan

2009, 10%

2011, 12%

2014, 7%

2015, 5%

Source: Center for Healthcare Research & Transformation.

Michigan’s Troubling Health Care Rankings

Access to health care (19th)

Health Care Affordability (30th)

Child dental visits (43rd)

Child wellness visits (38th)

Health care quality (38th)

Hospital readmissions (48th)

Nursing home citations (44th).

Source: U.S. News and World Report.

Weak Rankings, But Centers of Excellence

Meantime, a national health care survey by U.S. News and World Report ranked Michigan 34th for overall health care (with 1st being best in the nation). It’s somewhat ironic, then, Michigan is also noted for its centers of world-class health care. The University of Michigan Health System was ranked sixth in the nation in 2017 by U.S. News, a rating that accounted for quality of care, clinical resources, attention to families and other measures. Nine specialty areas ranked in the top 10 in the nation.

Prenatal Issues

Prenatal care has a direct bearing on infant wellbeing. According to Kids Count Michigan data for 2017, 31 percent of mothers did not receive adequate prenatal care before giving birth. Twenty percent of mothers reported smoking during pregnancy, with higher rates in rural areas.

Dental care also plays an understated role in overall health, as periodontal disease has been linked to heart disease.  A 2015 study, however, found that although Michigan has an adequate overall ratio of dentists to population, 77 of 83 counties have at least one dental shortage area. The problem is especially acute in rural areas and inner cities.

Related health and welfare coverage from our 2018 Michigan Issue Guide

Rural Care Gap

Access to health care – even for those with insurance - remains a particular problem in rural Michigan.

A 2015 study by the Citizens Research Council of Michigan found four rural counties in Michigan – Cass, Keweenaw, Lake and Oscoda – consistently fell below recommended ratios of primary care physicians to population. Seven other rural counties fell below suggested ratios in every field it examined except family practice.

The Center for Health Workforce Studies of the Association of American Medical Colleges projects a shortage in Michigan of 4,400 doctors - including both primary care doctors and specialists - by 2020.

Decline of Primary Care Physicians

The percentage of medical students choosing to specialize in primary care - the backbone of rural health care - has declined significantly. According to the American Academy of Family Physicians, about half of U.S. doctors in 1960 were primary care physicians. It is about 25 percent today.

Michigan also gets substandard marks for its rate of immunizations. A 2016 study ranked the state fourth worst in the country in its percentage of 15-month to 35-month-old children given a particular series of shots.  Only Idaho, West Virginia and Wyoming ranked lower.

National Issue

Of course, Michigan’s health care issues cannot be divorced from the nation’s health care system and policies. It’s frequently noted that the United States spends more per capita on health care than any other nation, yet trails many developed nations in basic measures such as life expectancy, infant mortality and access to care. Almost without exception, higher-performing nations have universal health care coverage and a single-payer system.


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