DETROIT — As the nation heads into the second year of the Affordable Care Act's health insurance overhaul, states are preparing for open enrollment starting Saturday. Here's a status report on Michigan, as well as answers to some of the key issues facing consumers:
Q: How many people enrolled via the exchange in Michigan during the first round, and what is the target number this time?
A: About 275,000 people had signed up through the health insurance marketplaces, also known as exchanges. The state says it expects more this year because some plans have been discontinued but doesn't provide a target. According to federal data, there are about 250,000 eligible state residents who haven't signed up.
Meanwhile, the state is exceeding expectations with its Medicaid expansion program. Since its April launch, nearly 450,000 people have enrolled with the Healthy Michigan Plan, which extends health care benefits to poor and low-income residents. Officials set a goal of about 300,000 for 2014, and estimated that 470,000 would eventually be enrolled.
Q: What is the state doing to boost enrollment with hard-to-reach groups?
A: The state's Department of Insurance and Financial Services says it relies on federally selected and funded health care navigators to reach out and help enroll people, and those efforts often are affiliated with nonprofit and social service agencies that already connect with many deemed hard to reach. Both navigators and state officials also capitalize on media as well as online and social media to get the word out. One organization in particular, the Michigan Consumers for Healthcare, coordinates with more than 200 other groups statewide and aims to reach poor and vulnerable populations in every one of Michigan's 83 counties.
Q: How well are the exchange websites working, and what is the likelihood that technology and software problems again mar the consumer experience?
A: State officials are taking a wait-and-see approach, but experts say consumers likely won't encounter the problems that greeted them during the first round. The marketplace has "certainly improved," said Marianne Udow-Phillips, director of the Center for Health Care Research and Transformation at the University of Michigan. She said significant improvements were made during the last open enrollment, and expects consumers will find it "easier to shop" and an "easier entry point."
Q: What is happening with health plan costs? Are premiums, deductibles and co-pays rising?
A: There's a wide range but an overall upward trend on the state marketplace, which increases from 12 to 16 carriers this time around. Some smaller carriers are coming in with decreases or lower increases, while the largest player, Blue Cross Blue Shield of Michigan, is reporting increases in the 9-10 percent range. For its part, Blue Cross says its rates increased to reflect the claims processed and health care needs provided for members. The state marketplace offers five different levels of coverage that range between a 3 percent decrease and a 7 percent increase. Government subsidies have worked to lower costs of premiums — Blue Cross says about 5,000 of its customers aren't paying anything because of subsidies. Udow-Philips says a big concern for consumers is the rising cost of co-pays and deductibles, which also is a trend among private insurance plans.
Q: What if consumers don't buy health insurance?
A: The penalty is going up for people who go without health insurance. It's at least $325 per adult, or 2 percent of income, whichever is greater, up to a cap.
Q: Have consumers been experiencing trouble actually seeing primary care physicians or specialists?
A: Udow-Phillips says her center's research has found that there are neither accessibility problems for consumers nor capacity problems for physicians
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