A small Muskegon health plan designed for small businesses has reopened enrollment for the first time in a few years.
Access Health had to halt new enrollments in 2018 and focus on existing enrollees after losing about $2 million in state and federal Medicaid funding that helped to pay the cost of health premiums for employees at participating small businesses.
After securing a waiver for innovative health coverage that temporarily restored the lost funding, Access Health reopened enrollment in December for small businesses in Muskegon County and northern Ottawa County that are unable to afford commercial employee health coverage.
“Too many residents can’t afford commercial health insurance and are forced to go without coverage. Our community created Access Health to help residents access the medical care they need to address significant personal health concerns,” said Access Health Executive Director Jeff Fortenbacher.
Access Health has been using reserve funds to cover the lost state and federal funding. The temporary support for Access Health should last at least a year and a half. Afterward, “we’re going to need to do something,” Fortenbacher said.
Known as a three-share model, Access Health uses low-cost premiums paid by both employers and employees, plus federal Medicaid funding that’s funneled through the state, to support coverage that’s typically been bought by small businesses in low-wage sectors.
The one-time waiver that restored funding temporarily allowed the health plan to reopen enrollment as it continues work on a permanent funding solution, Fortenbacher said.
“It’s a one-time designation that gives us a little bit of a bumper,” he said. “There’s a lot of moving parts, but the main thing is we opened enrollment at least for the next year due to a one-time subsidy.”
Created in 1999 at a time when the ranks of the uninsured was steadily growing amid the rising cost of health insurance, Access Health presently provides coverage to about 500 people who work at 150 small businesses in Muskegon and northern Ottawa counties. At one point, Access Health covered about 1,300 people.
Access Health offers health coverage at a monthly premium that typically costs $75 and includes primary care, hospitalization, and behavioral health. The health plan comes with $10 copays for physician office visits and a $300 maximum out-of-pocket cost for inpatient hospitalization. The coverage, with an emphasis on health wellness, care management and preventative care, is good at Mercy Health in West Michigan.
The coverage is designed to provide a bridge for small businesses that have been unable to afford a health plan for employees until they can transition to the commercial health insurance market.
The passage of the federal Affordable Care Act in 2010, and provisions that phased in over a period of years, led to the funding cut for Access Health’s Medicaid share, Fortenbacher said. The ACA expanded Medicaid and introduced subsidies to help individuals who met eligibility requirements to buy health coverage, shifting the focus away from supporting three-share plans such as Access Health, he said.
“When the ACA came out, basically a lot of political will went away for programs like these,” Fortenbacher said. “They pretty much re-allocated it to the subsidies.”
If a sustainable funding solution through legislation is not secured for three-share plans: “We’ll need to look at doing something different with the program,” Fortenbacher said.
“I’m not going to continue to do something that does not have a long-term type of ability for an outcome,” he said. “I’d rather take the dollars we have left and really invest them in something that’s disruptive or whatever to the systems, versus kind of continuing the status quo.”
In reopening enrollment, Fortenbacher hopes Access Health can grow enrollment back to 900 to 1,000 people at about 250 small businesses.
Fortenbacher views the restoration of new enrollments as enabling Access Health to help small businesses that are presently competing for employees in a tight labor market and worker shortage.
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Senior writer, covers health care, finance and life sciences. Twitter: @masanche
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