Marianne Udow-Phillips, Director of the UM Center for Healthcare Research, is not making any more predictions.
At least, not about health insurance coverage rates in Michigan.
"You know I hesitate to make forecasts," she says with a rueful laugh, "because the Healthy Michigan (Medicaid) program and the (individual) health insurance exchange blew through all forecasts - forecasts we made, forecasts the federal government made, and forecasts the state made last year."
The numbers surprise, in a good way
"Last year, the federal government thought in Michigan we'd enroll 161,000 people in the health insurance exchange," says Udow-Phillips, a former Blue Cross Blue Shield of Michigan executive and former Director of the Michigan Department of Human Services. "And we in fact enrolled 272,000. And for Medicaid, the state - and we agreed - we thought there would be 322,000 enrolled in the first year. Already we're at
487,000 and we're not even through the first year."
Udow-Phillips attributes the whopping sign-up rate to pent up demand. Most of the people signing up for a Medicaid insurance plan had no health insurance coverage before, or, very poor coverage.
That's also the case with a fair number of people signing up for individual insurance plans on the health insurance exchange.
That's the group that faces tax penalties for being uninsured. But Udow-Phillips thinks the tax penalties aren't playing a big role in convincing people to sign up - yet.
"The penalty does grow over time, but even now it can be 1% of income. And that can be significant for some people. But I just don't think there's much awareness of it yet."
The big numbers are likely to add up to big savings
Right now, the federal government is picking up 100% of the tab for the Medicaid expansion. But by 2020, Michigan will have to pay 10%.
Udow-Phillips says that shouldn't be a problem - if the state makes the right choices about the budget.
Before the Affordable Care Act was enacted, Michigan paid for most of the mental health care for Medicaid patients in the state. Now, the federal government does that. Udow-Phillips says that could add up to a billion dollars over ten years.
She says that would be enough to pay for the state's portion of the Medicaid expansion for some time.
Competition is thriving
In 2015, 135 additional health insurance plans will participate in the health insurance exchange. The exchange is where individuals and families can go to purchase plans. 87% of people so far who've done that have received a tax credit to help pay for the insurance.
Medicaid plans are fiercely competing for the new enrollees, too, some offering to pay for a bus or taxi ride to get kids to their well-child visits if the family has no car.
"So despite the controversy, and debate in public," says Udow-Phillips, "clearly the marketplace is saying this is something that's here to stay."
Still many more to go
Udow-Phillips says there are still 700,000 people in Michigan who are eligible for Healthy Michigan - the state's name for its Medicaid health insurance program.
There are a number of reasons they haven't signed up, even though in many cases their costs are negligible.
"Many are unaware they are eligible," Udow-Phillips says. "Some see Medicaid as a welfare program and they don't feel that's what they should be doing. Some are very hard to reach. They don't have phones, cell phones or good transportation. This is a more challenging population to get to and we've just got to keep working at it."
