Care for the Sick
March 24, 2017
EAST LANSING, Mich. – Professor Charles Ballard, a former chair of the economics faculty at Michigan State University, makes his living by analyzing data, not by emotional appeals.
He’s an expert on the effects of trade and tax policies, on trends in income inequality, and perhaps most of all, on Michigan’s economy.
So when I asked him to assess the likely impact of the Republican health care bill now before Congress, his reaction was stunning: Pass this bill, and people will die.
“If the ACA (the Affordable Care Act) is rolled back, it is nearly certain that many Americans will lose their health insurance,” Ballard said. “The exact number is … likely to be in the millions nationally and in the tens or hundreds of thousands in Michigan. If that happens, every year more and more will die needlessly.”
Ballard’s estimates may be, if anything, conservative. The non-partisan Congressional Budget Office estimated that the number of Americans without insurance would jump by 24 million in the next nine years. Most of those – 14 million – are people who as a result of the ACA, or “Obamacare” became eligible for Medicaid.
Michigan has been one of the major beneficiaries of that provision. The Affordable Care Act offered states a stunning deal. They could opt for expanding Medicaid to adults and families whose incomes were slightly higher than poverty level.
For a single person, that meant living on no more than $16,400 a year; for a family of four, that could be up to $33,000.
Folks below that line can now get health insurance, if a state opted in. What’s more, the federal government picked up all the costs for the first three years, and individual states would never have to pay more than 10 percent. Even so, Medicaid expansion was bitterly opposed as “more socialism” by some conservatives.
Gov. Rick Snyder, however, saw this as a tremendous plus for Michigan, especially in terms of having a healthy work force. He succeeded in getting the legislature to approve this in August, 2013. State officials believed this would lead to 320,000 citizens signing up for Medicaid who had no health insurance before.
They were way off — it was twice as many. Currently, some 640,000 Michigan residents have health insurance through Medicaid because of the Healthy Michigan plan.
Statistics show this has been an enormous economic benefit for the state – and not just because a lot of people are healthier because they have medical care.
Marianne Udow-Phillips, a former director of the Michigan Department of Health and Human Services, now runs the non-partisan Michigan League for Public Policy’s Center for Healthcare Research. She said the expansion has created 30,000 new jobs every year and generated $2.3 billion in additional personal spending power.
What’s more, her numbers show that hospital costs have fallen dramatically since more people have insurance and they no longer had to provide as much uncompensated care.
The year Medicaid expansion was passed, Michigan hospitals provided $627 million in uncompensated care. Two years later, that had been cut almost in half, to $332 million.
This year, for the first time, Michigan will have to pay a share of the costs if the expansion – five percent of the total bill.
But that may be more than covered by the extra boost the expansion is providing the economy, including an estimated $150 million in state tax revenue because of all the new jobs.
In January, a team of University of Michigan economists, health policy experts, and medical professionals published an article. “Economic Effects of Medicaid Expansion in Michigan,” in the prestigious New England Journal of Medicine. They were even more bullish on the positive financial effects of the expansion.
“Our results indicate that continuing Michigan’s Medicaid expansion and beyond will have clear economic benefits for the state,” concluded the team, whose main author was Dr. John Ayanian, a medical doctor and director of the university’s Institute for Health Care Policy and Innovation. “The state budget gains outweigh the added costs for the next five years, and probably longer,”
Snyder has made it very clear he thinks Healthy Michigan is worth preserving. But he doesn’t have any clout to speak of with President Trump, who pointedly noted during a recent visit to Michigan that he is quite aware the governor didn’t endorse him.
Nobody is denying that there are defects in Obamacare. “The Affordable Care Act is certainly not perfect, and it does need to be fixed to better serve consumers, but overall, it was a groundbreaking policy that significantly reduced the number of uninsured in Michigan and improved people’s health,” said Gilda Jacobs, a former respected state senator who now heads the Michigan League for Public Policy.
However, those in power aren’t interested in fixing the act. Ballard, the author of a well-regarded book, Michigan’s Economic Future, thinks that future is bound to be bleaker if the health insurance plan now before Congress replaces the ACA.
Were it up to him, he would solve America’s health care problem by extending Medicare to the non-elderly population. “A system of Medicare for all would achieve universal coverage and lead to a dramatic reduction in administrative costs,” he said.
Sadly, he added, the power of private insurance companies have made that impossible. However, Ballard still thinks that the more people are insured, the better off the state would be, even if that means he would have to pay more taxes.
Stepping out of his academic role, he added “Why? Because I am a member of a community. I am a citizen of the state of Michigan and the United States of America, and I believe in the Biblical admonitions to feed the hungry … and care for the sick.”
And besides, he added, in this case a moral compass makes economic sense.
is the head of journalism at Wayne State University, serves as Michigan Radio’s senior political analyst and writes regularly for several publications. He also serves as The Toledo Blade’s writing coach and ombudsman and is host of the weekly television show Deadline Now on WGTE-TV in Toledo.