Benefits and Business Tax Credits
The Affordable Care Act (ACA), which became federal law in 2010, provides Michigan residents with vital protections and benefits. Learn more about getting the most from healthcare coverage, what protections you have as a healthcare consumer thanks to healthcare reform, and how Michigan’s small businesses benefit from the ACA.
Getting more out of your healthcare coverage
Did you know? Thanks to health reform, 80 cents out of every dollar in healthcare premiums must be paid out to for a policyholder’s medical care. If the full 80 percent is not paid out, the Affordable Care Act (ACA) stipulates that your insurance company must send you a refund check every year. Here in Michigan, Michigan Consumers for Healthcare have already made a difference on this front! When the state of Michigan asked for a waiver to divert more than $53 million in consumer rebates back to the insurance industry, our coalition members fought that ruling and won! Because of the Michigan Consumers for Healthcare members, a federal ruling denied the waiver request – meaning less of your healthcare dollars go to insurance industry salaries and bonuses. This rule is referred to as the “medical loss ratio” provision of the Affordable Care Act.
Community Health Centers
Community Health Centers will help nearly double the number of patients seen by the centers over the next five years. The funding could not only help the 184 Community Health Centers in Michigan, but also support the construction of new centers.
Choice and access
Patients’ choice of doctors will be protected by allowing plan members in new plans to pick any participating primary care provider.
Affordable insurance for uninsured with pre-existing conditions
$141 million federal dollars are available to Michigan to provide coverage for uninsured residents with pre-existing medical conditions through a new transitional high-risk pool program, funded entirely by the federal government. The program is a bridge to 2014 when Americans will have access to affordable coverage options in the new health insurance exchanges and insurance companies will be prohibited from denying coverage to Americans with pre-existing conditions. If states choose not to run the program, the federal government will administer the program for those residents.
Insurance companies are no longer be able to place lifetime limits on the coverage they provide, ensuring that the 6 million Michigan residents with private insurance coverage never have to worry about their coverage running out and facing catastrophic out-of-pocket costs.
Insurance plans’ use of annual limits will be tightly regulated to ensure access to needed care. This will protect the 5.5 million residents of Michigan with health insurance from their employer, along with anyone who signs up with a new insurance plan in Michigan.
Insurance companies will be banned from dropping people from coverage when they get sick, protecting the 459,000 individuals who purchase insurance in the individual market from dishonest insurance practices.
Health insurers offering new plans will have to develop an appeals process to make it easy for enrollees to dispute the denial of a medical claim.
Specific benefits to small business
132,000 small businesses in Michigan could be helped by a new small business tax credit that makes it easier for businesses to provide coverage to their workers and makes premiums more affordable. Small businesses pay, on average, 18 percent more than large businesses for the same coverage, and health insurance premiums have gone up three times faster than wages in the past 10 years. This tax credit is just the first step toward bringing those costs down and making coverage affordable for small businesses. Who qualifies as a small business?
- Employers with fewer than 25 full-time employees and pay wages averaging less than $50,000 per employee per year may qualify.
- Employers with more than 25 employees may also qualify if some of their workers are part-time.
- Small businesses can claim the credit as part of the general business credit starting with the 2010 income tax return they file in 2011.
Healthcare Exchanges (Exchanges) will be established in every state. For the business community, a Small Business Health Options Program (SHOP) will be developed within our state healthcare Exchange. The SHOP will be an online marketplace where all qualifying small businesses are grouped together to create a larger risk pool that helps lower premium costs for all. Using a combination of this spread risk and advanced technology, small business owners can access lower-cost insurance plans described in simple language, and be assured that all plans offered on the Exchange provide a comprehensive level of coverage required by law. The Exchanges allow small business owners to compare plans using an “apples-to-apples” approach, making it easier for each individual business to find the right insurance plan for their employees—all provided through private insurance carriers. Exchanges enhance private insurance options for small business and protect the insured with higher standards and lower premiums. Exchanges are not government health insurance.