Working Together For Michigan Consumers To be Healthy


The Affordable Care Act (ACA), which became federal law in 2010, includes vital protections and benefits for Michigan residents. Some of these protections are being phased in, and some have already taken effect.


Q: How does the new health reform law benefit women in Michigan?
A: The health reform law provides several protections for women by offering better access to affordable coverage, by ending insurance practices that discriminate because of gender, and by expanding coverage for children and helps pay for long-term care.


Q: What does the ACA do for prevention?
A: It requires new plans to cover prevention and wellness benefits at no charge by exempting these benefits from deductibles and other cost-sharing requirements. It also eliminates copayments for preventive services and exempts preventive services from deductibles under the Medicare program beginning in 2011. Health reform also ensures coverage of prevention and basic health services, including maternity benefits, in the new health exchanges to create a system that encourages innovations in health care to prevent illness and disease before women require more costly treatment. Today, maternity benefits are often not provided in health plans in the individual insurance market.


Q: How does the ACA improve access to care for women in Michigan?
A: Health plans can no longer require pre-authorization or referral for OB-GYN care.


Q: What are other ways the ACA improves access to coverage?
A: The new law provides better access to doctors and nurse practitioners who provide primary care services. This will help improve care for women with chronic health conditions who often require ongoing health care. These provisions start in 2011.


Q: How will health reform changes that take effect in the future help women?
A: Here are two examples:

  1. Beginning in 2014, the law ends the common practice of “gender rating.” In other words, an insurer will no longer be able to charge women more than men for the same coverage. This applies to those with individual coverage and to small businesses with up to 100 employees.
  2. Starting in 2014, insurance companies will no longer be able to deny you coverage because of a pre-existing condition such as domestic violence, breast or cervical cancer, pregnancy, or C-section.

Healthcare reform offers a long list of general benefits to consumers. Keep reading for a few examples.


Q: How much of my dollars are actually going toward my care?
A: That’s a great question! 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.


Q: How does the ACA help Community Health Centers?
A: Health reform 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.


Q: Will Michigan consumers have more choices?
A: Yes. Patients’ choice of doctors will be protected by allowing plan members in new plans to pick any participating primary care provider!


Q: What about pre-existing conditions.
A: $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.


Q: What does the new law mean?
A: 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.