Preparing for healthcare changes this fall

As October nears, how will the Patient Protection and Affordable Care Act (ACA) affect you and your family?

“The reform will affect different people in different ways,” said David K. Jones, a doctoral candidate at the University of Michigan’s School of Public Health, whose dissertation research examines the role of states in implementing the new healthcare law.

IMG_7584This week, local experts explain some of the basics of healthcare reform to help you understand some of the changes.

More health coverage for kids

One of the most beneficial provisions of the ACA in Phyllis Meadows’ eyes is that more children will have health coverage.

Meadows, Ph.D., is the associate dean for practice and a clinical professor in the University of Michigan’s School of Public Health.

“The current health coverage system—Medicaid or MIChild (which provides coverage for children of uninsured working families in Michigan) still has several thousand eligible children who have not been enrolled in the program,” Meadows said. “There are still a number of children out there who, regardless of ‘Obamacare,’ haven’t been enrolled in existing programs.”

“So one thing that I see the ACA will do in a positive way is move these children into health coverage.”

Another valuable but indirect impact toward the future health of children in the state is providing preventive health resources for parents, Meadows said.

“Stabilizing and making sure that parents are healthy is one of the best things you can do for children,” she said. Having just one parent who becomes ill, without healthcare, “can move a family from a thriving family to a homeless family.”

To do so, the ACA will provide prevention resources such as early screening as well as working to engage adults in healthier behaviors—“that’s an advantage for children,” Meadows said.

Sometimes healthy living starts at school for children and it is another piece of the reform geared to help Michigan’s youth, Meadows says.

“What we know about school-based health centers is that they are a valuable resources for children and the school particularly for those children who have preexisting conditions like asthma,” she said. “Those centers have been demonstrated to show that if you have health resources within the school available for children, children have fewer absences and parents are more productive (not taking days off).”

The ACA supports school-linked health centers for students but Meadows is uncertain as to whether the law will push to expand the number of programs in the state or enhance the quality of those in place.

No insurance caps for preexisting health conditions

Meadows also points out a piece of the ACA that will be a widespread gain.

Health insurance companies will no longer be able to place a limit on coverage for children and adults with preexisting medical conditions.

“Prior to ‘Obamacare,’ insurers could put a cap on how much they were willing to spend on the cost of (your) child’s care,” she said.

For lower-income families, this was not such a big challenge because there are provisions in current laws that allow those children to be covered under Medicaid, Meadows said, but for the working mom or dad it’s a big advancement.

She gives the example of a dad working as a local teacher whose child reaches the maximum benefits due to chronic condition.

“He doesn’t want to go on Medicare because he may have to quit his job to be eligible or his wife may have to quit her job to be eligible,” Meadows said. “The provisions in the ACA say that insurers—private or otherwise—cannot put a cap on the cost of care for that child—I think that’s a huge deal.”

Coverage for adult children

Who says 26-year-olds can’t be considered kids? Under the new law, parents can provide health insurance for their children up to age 26, if your plan includes children, of course. And this provision is already in place. For more information, check out

The uninsured will be insured

One of the main goals of President Obama’s ACA is to have an insured American population.

“Everyone will have a requirement to obtain a minimum level of insurance,” Jones said.

But it’s not free insurance, as policy provider Rick Young, of Rick Young Insurance in Rochester explains.

“(For) some people, it will be (free) based on their income,” he said, “but it’s not that everybody has free insurance.”

Government subsidies will be available

Through Michigan’s health insurance exchange or through Medicaid, government subsidies will be available to help low-income families attain coverage.

“Subsidies are based on an income,” Young said. “It’s also based on how many people you have in your family or if you’re single.”

Young provides a rough idea of a family who would qualify for such subsidies. “For a family of four, it’s around $92,000 or less a year—If you make less money than that, you’ll qualify for a subsidy,” he said.


Last year, the Supreme Court ruled that the law’s provision regarding Medicaid expansion—to include low-income families up to a certain level—is optional for states. So this week, the Senate will vote whether or not Michigan will adopt this bill, Jones said.

“Medicaid is currently not a program for poor people, but only for poor people who fit into certain categories,” he said. “The ACA included an expansion of the Medicaid program so that all people up to a certain income level, regardless of whether they fit into certain categories, would be eligible.”

If the bill passes, more low-income families will have access to health insurance, Jones explains.

To learn more, Jones suggests visiting the Center for Healthcare Research and Transformation.

Hospitals prepare for more patients

Healthcare hubs like Crittenton Hospital Medical Center expect to see a climb in patient visits since the previously uninsured will have coverage under the new law.

“We expect our volume to go up,” said Donna Kopinski, chief financial officer for Crittenton.

“But unfortunately, the government is going to have to pay for that volume—so we expect the payments (to Crittenton) to go down—compared to what we’re getting paid today from Medicare and Medicaid.”

Kopinski sees the upcoming healthcare reform as an ongoing process and as time passes, Crittenton will address shifts in patient demographics.

“We’re trying to look at that patient population to determine where’s the best place for that patient to get the care and then we’ll have to determine if we’ll have to hire more(staff) or not at that point in time,” she said.

Higher premiums on the horizon

“The bill is called the Affordable Care Act and what’s going to happen is that these premiums—this is one thing that everybody agrees on—these premiums are going to sky rocket—they’re going to be higher,” Young said.

Those affected by higher premiums are likely to be the self-employed or those who purchase individual plans. At this point, it is difficult to know how group plan premiums will be influenced.

As a policy provider, Young has been proactive in contacting his clients to share what he has learned of the healthcare changes.

“It’s going to take me a few months to explain what’s going to happen, what their income is and give a projection of whether they should try to keep the plan until December 2014,” he said. “Or because it’s going to be so much higher or because of their income level, they’re going to qualify for such a large subsidy that they’ll be better off changing on Jan. 1.”

“I put (those clients) in a file to call them back in the fall, when we have solid rates and subsidies and tell them exactly whats going to happen to them.”

“It’s a long, very complicated process…we’re all spending a lot of time trying to understand the law and trying to explain generalities,” Young said, “because I don’t have all the facts yet.

You can learn more about calculating your projected insurance premium rate through the Henry J. Kaiser Family Foundation.

Who the fall insurance exchange will affect

Open enrollment for the health insurance exchange will begin October 1.

Since legislature chose for the federal government to run Michigan’s exchange, there are several implications following this, Jones said.

“The most important point to realize is that (the exchange) only affects two groups of people—those who do not get insurance through their employer (the unemployed or self-employed) and those who get insurance through a small business (of less than 50 employees).”

How will the exchange work?

Those falling in the two groups will be able to visit a website that will compare insurance plans, Jones said.

For more information, you’ll want to visit or,5269,7-303–305730–,00.html.

Insurance exchange to increase options and competition in Michigan? Some are skeptical

Another goal of the law is to offer a greater variety of insurance companies to states and their residents, creating more competition in the marketplace. But policy providers like Young worry that it may do the opposite, at least in the immediate future.

“Right now, if you want to go buy a policy, there is HAP (Health Alliance Plan), Blue Cross Blue Shield, Humana, Assurant, United Healthcare, HealthPlus—I can go on,” Young said. “(Some of) those carriers have chosen not to go on the exchange because of the way the exchange is set up.”

Staying informed

To stay abreast of the latest health reform information, on Tuesday, June 25, the Michigan Department of Community Health will hold a series of public forums on Medicare and Medicaid. From 10 a.m. to 1 p.m., the panel will be held at the Forfa Auditorium of Henry Ford Community College in Dearborn. For more information, be sure to visit

Other helpful sources to help answer your healthcare questions include the Center for Healthcare Research and Transformation,,, the Department of Insurance and Financial Services (DIFS) as well as the Henry J. Kaiser Family Foundation, which specializes in health policy analysis.

About Jen Bucciarelli

Veggie lover and aspiring word chef, reporter Jen Bucciarelli covers all things health and medicine for Rochester Media and The Community Edge. She is always on the hunt for local experts who can help improve the lives of our readers. Send her a note at

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