It was in early 2021 that Congressional Democrats passed & President Biden signed the American Rescue Plan Act (ARPA), which among other things dramatically expanded & enhanced the original premium subsidy formula of the Affordable Care Act, finally bringing the financial aid sliding income scale up to the level it should have been in the first place over a decade earlier.
In addition to beefing up the subsidies along the entire 100 - 400% Federal Poverty Level (FPL) income scale, the ARPA also eliminated the much-maligned "Subsidy Cliff" at 400% FPL, wherein a household earning even $1 more than that had all premium subsidies cut off immediately, requiring middle-class families to pay full price for individual market health insurance policies.
Here's what the original ACA premium subsidy formula looked like compared to the current, enhanced subsidy formula:
Yep, my wife & I screwed up royally. Yes, I know: I'm "The ACA Guy" and yes, it's incredibly embarrassing to tell this story, but I'm doing so in the hopes of helping others avoid making the same mistake.
It's been several years since we enrolled in an ACA policy ourselves via HealthCare.Gov, since we were enrolled in my wife's student plan up until recently (she returned to college to get her master's degree). The last few times we were able to enroll or renew our policies without any issues, so we assumed it wouldn't be an issue this time.
However, there seem to have been a few changes to some of the questions during the application process, and one of them threw us for a loop.
In the household income section of the application process, Healthcare.Gov asks both how much you expect to earn this month specifically (November 2024) as well as how much you expect to earn for all of 2025.
It was the first of these questions which is what caused the problem for us.
You see, both my wife and I are self-employed, which means we have highly variable incomes--we may earn $10,000 one month but not earn anything the next.
Cut to 2024: Michigan Democrats now hold control of the state Senate as well as (barely) the House...and Democratic Representative Kevin Hertel is now Senator Kevin Hertel, who also happens to be the Health Policy Committee Chair...and one of his priorities this session, according to his latest constituent newsletter, is indeed to move Michigan to a state-based ACA exchange:
Legislative Updates
Expanding Access to Health Care Through a State-Based Exchange
The Michigan Dept. of Financial Services hasn't issued any press release yet, but nearly all 2025 preliminary rate filings for the MI individual and small group markets are available via the SERFF database.
The most noteworthy item in Michigan's individual market is that there's a new entry: HAP CareSource. I'm assuming this is some sort of joint insurer effort by CareSource and Health Alliance Plan (which has only offered off-exchange ACA plans for several years now) but am not certain about that.
In terms of actual rate hikes, most of them are in the mid single digits, but Priority Health, which holds exactly 1/3 of the market share (equal to Blue Cross when you combine their PPO & HMO divisions), is seeking an eye-opening 18.9% average rate increase.
With Priority Health included in the mix, rate increases being requested by Michigan indy market carriers average 10.5% for 2025.
The Michigan Legislature is considering joining the 18 other states that have established state-run health insurance marketplaces through HB 6112. Having an exchange run by the state instead of the federal government, supporters of the bill say, will save Michiganders money by leaving the “rigid and inflexible” federal market for a Michigan-tailored market that can be more responsive and potentially lower premiums. The bill is still in the early days of the legislative process, awaiting a vote from the House Health Policy Committee.
...It's particularly noteworthy that not only is a Republican legislator the primary sponsor of the bill (Mark Tisdel), but so are 4 of the other 7 cosponsors (John Roth, Bradley Slagh, Jim Lilly and Gary Howell)...along with three Democratic state Representatives (Jim Ellison, Sara Cambensy and Kevin Hertel).
Yesterday, however, the Michigan Dept. of Insurance & Financial Services posted the final/approved rate filings for 2024, and while there were only a couple of very minor tweaks to most of the preliminary requests, there's one important change: US Health & Life Insurance Co. is no longer going to be on the Michigan individual market at all:
Open Enrollment for 2024 health insurance runs from November 1, 2023 through January 15, 2024
(LANSING, MICH) Today, Governor Gretchen Whitmer and Michigan Department of Insurance and Financial Services (DIFS) Director Anita Fox are kicking off the annual Health Insurance Marketplace open enrollment period by reminding Michiganders that they may qualify for low- and no-cost coverage and free local assistance is available to help them get the insurance coverage they need. Open enrollment begins today and runs through January 15, 2024. For 2023, qualified enrollees, on average, saved more than $400 a month.
Last month I noted that Michigan legislative Democrats were planning on passing a package of bills designed to repeal a bunch of restrictions on abortion & other reproductive healthcare:
Dems to end 24-hour abortion waiting period, ban on Medicaid funding of procedure
LANSING — Michigan Democrats said Wednesday they will repeal laws that require a 24-hour waiting period to have an abortion performed, impose what they say are costly and unnecessary regulatory burdens on abortion clinics, prohibit abortions funded by Medicaid, and ban private health insurers from automatically covering abortions under standard policies.
The list includes 9 major items (some of which actually include a lot more than one provision within them). It really should include ten, since I forgot about implementing a Basic Health Plan program like New York and Minnesota have (and as Oregon is ramping up to do soon as well), but it's still a pretty full plate.
Last Tuesday I noted that a package of bills designed to codify various ACA protections into state law here in Michigan (most of which are low-hanging fruit of my own healthcare wish list which I posted back in February) had managed to make it halfway through the legislative process: Five of them have passed the Michigan House, but not the Senate; the other three have passed the Michigan Senate...but not the House. I applauded the state legislature for pushing these bills halfway through and encouraged them to get the other half of the job done.
