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    While Michigan is on the path to expand Medicaid and to implement a partnership health exchange system under the Patient Protection and Affordable Care Act (PPACA), a recent report has shown that many states are behind on passing the most fundamental PPACA consumer protections. It has been found that only eleven states and the District of Colombia have passed laws needed for the state governments to be able to implement the new laws. The other thirty-nine states, Michigan being one of them, are limiting their ability to enforce the laws, and they will not be able to ensure that consumers are receiving their full protections under the law. If states do not change their insurance regulation rules by the time the federal rules go into effect by next January, the federal government may have more work on their hands than initially expected. The federal government may have to step in and enforce state actions if the states do not show progress in passing the necessary laws needed to enforce the laws themselves. Besides implementing these necessary laws, states also have to make decisions on their state-specific health insurance exchange and whether or not they want to expand Medicaid. .
    As of December 17, 2012, seventeen states and the District of Colombia have decided on the intention to establish state-based exchanges, while seven states have declared their intention of pursuing a partnership exchange. That leaves twenty-six states that are resorting to a federally-controlled exchange. This is a considerable amount of work that the federal government did not anticipate they would have. While only seventeen states have agreed upon a state-based exchange, forty-three have received grants from the federal government to plan and/or establish health exchange systems. Maine, New Hampshire, Wisconsin, Kansas, Oklahoma, Louisiana, and Florida all returned the federal grants back to the federal government due to their declinations of implementing a state-based exchange. There have been three levels of awarded grants to the states: Planning, Level One, and Level Two. For the states that opted to receive the grants, they first received funds to plan out their exchanges. In 2011, states were able to move from the planning stage to the Level One round of funding. These grants went to supporting the development and implementation of exchanges. Level Two grants are awarded once significant progress has been made on establishing an exchange. Thirty-four states and the District of Colombia have received Level One grants, while twelve states have received Level Two grants.
    States also have the power to decide whether or not they want to expand their Medicaid program or not. If a state does choose to expand their Medicaid programs and cover low-income people that were not covered otherwise then the federal government will pay for the expansion for the first three years and then pay ninety percent of the costs after that. This would expand Medicaid to an estimated twenty-one million people. While many states would like to expand their programs, they also worry that the federal government might not hold its end of the bargain and the costs would be taken up by the states. Currently, states can decide to refrain from expanding their Medicaid programs, or they can postpone their decision. For states that think they want to expand Medicaid, acting sooner than later works to their benefit. The federal government will only fully fund their expansion through 2016. Up until now, only seventeen states and the District of Colombia have agreed to expand their Medicaid programs while eleven Republican-controlled states have refused the offer. The states that are remaining are still debating their final decisions.

    Sources:

    http://www.cbpp.org/files/CBPP-Analysis-on-the-Status-of-State-Exchange-Implementation.pdf

    http://www.detroitnews.com/article/20130118/BIZ/301180349/Michigan-health-exchange-to-get-$31M

    http://news.heartland.org/newspaper-article/2013/01/03/michigan-legislature-decides-against-state-obamacare-exchange

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    The Michigan Policy Network is a student-led public education and research program to report and organize news and information about the political process surrounding Michigan state policy issues. It is run out of the Department of Political Science at Michigan State University, with participation by students from the College of Social Science, the College of Communication, and James Madison College. 

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    Meet your Policy Fellow: Leah Brynaert

    Leah Brynaert is Health Care Fellow & Correspondent for the Michigan Policy Network. She is a first-year student in Lyman Briggs College at MSU.