LANSING – A program that has provided health insurance to more than 600,000 working persons in the state – and that was approved after a major political struggle – faces an uncertain future with the election of President-elect Donald Trump, but most observers and officials involved in the creation of Healthy Michigan say they expect it will be changed and not ended.

The prospect that most intrigues some of those officials is the idea that under Trump the federal government could reconstitute Medicaid – which provides health insurance coverage in the Healthy Michigan plan – so funding comes to each state as a block grant. Doing so would give the state more flexibility to draft rules and structure for the program.

Sen. Mike Shirkey (R-Clarklake), who as a member of the House in 2013 helped shepherd the controversial program into existence, said converting Medicaid into a block grant would allow all 50 states to experiment and innovate on to use the system that could help the most people.

“That would be just plain simply awesome,” Shirkey said.

The one thing no one seems willing to anticipate is that the Patient Protection and Affordable Care Act, also known as Obamacare to some, will be repealed with no replacement.

Trump campaigned on eliminating the controversial law completely but has said subsequently he would look at keeping some aspects such as preventing insurance companies from denying coverage for pre-existing conditions and allowing children to remain on their parents’ health insurance policy until they turn 26.

Those views were repeated by U.S. Sen. John Thune (R-South Dakota) in an interview on NPR Friday, where he also talked about making sure people not getting coverage through the health care exchange are not immediately cut off from coverage.

Ending the ACA in its entirety could mean those persons getting individual coverage through the exchanges or through expanded Medicaid could face difficulties getting any coverage. The trade publication Modern Healthcare said in a Friday article there are indications that insurance companies would simply stop writing individual coverage as early as 2017 if the ACA were repealed outright.

However, repealing the ACA outright could prove difficult politically, some observers and organizations, including the Center for Healthcare Research and Transformation at the University of Michigan, have said, if only because Democrats in the U.S. Senate could block efforts to end it.

That would put more focus on ending parts of the law and changing other parts. But one area that has largely not been discussed as protected is expanded Medicaid coverage for those persons with incomes up to 133 percent of the federal poverty level.

Rick Murdock with the Michigan Association of Health Plans said anyone involved in expanded Medicaid is feeling “angst” after the election, but the practical aspects of eliminating the program would prove complex.

“An abrupt repeal without some conversion would operationally take years,” he said, but nonetheless he expects change.

When Congress passed the ACA in 2010, it included a provision that all states had to expand eligibility for Medicaid to those with incomes of 133 percent of the poverty line. But when the U.S. Supreme Court upheld the law in 2012, it ended that provision, saying states could not be compelled into the expansion.

That set off political fights in a number of states, and many states have refused to expand coverage. Governor Rick Snyder called for expansion in 2013, and it took the Legislature much of the year before the proposal was finally approved.

Because the issue is still new, officials in Snyder’s administration were hesitant to speculate on its future.

Jennifer Eisner, spokesperson for the Department of Health and Human Services, said that, “given the ACA is currently the law of the land, we’re focused on improving health outcomes for the 600,000-plus residents enrolled in the Healthy Michigan Plan. Any comment on the future direction of health care coverage for this population would be hypothetical at this point. We will continue to work with our federal partners to convey the success of the Healthy Michigan Plan.”

And Kurt Weiss, spokesperson for the State Budget Office, said the state would have to know what the changes could be before it would know what the effect would be on Healthy Michigan and the state budget.

Under the expansion plan, the federal government paid the entire cost of the additional Medicaid recipients for the first years of the program, with a phase-in of state payments to 10 percent of the total additional cost. Murdock said that in fiscal 2017-18 – which will be the next budget presented by Snyder – the state would have to pick up another 1 percent of the cost for the expansion population.

Rob Fowler, president of the Small Business Association of Michigan – one business organization that was a major supporter of the Healthy Michigan plan – said it was critical for all persons, including those who support repealing the ACA, to remember that with or without health insurance, people will get health care. If needed, people without insurance will get treated at hospital emergency rooms, and the cost of uncompensated care will fall back on businesses and individuals with coverage through their premiums, he said.

“This is not a welfare debate, it’s a health care debate,” Fowler said, and complaints about increased premiums under the ACA cannot cover the fact that the costs will still be there if the ACA is eliminated.

Fowler said he is looking again at the “A Better Way” plan U.S. House Republicans proposed as an alternative to the ACA. While it would end Medicaid expansion, it would shift Medicaid to a block grant. That could allow the state to determine on its own who would be eligible for Medicaid and how they could be covered, he said.

Shirkey also said he was extremely interested in the possibility of Medicaid becoming a block grant for the overall opportunities it would present states to develop individual programs that other states could copy.

Shirkey also said recreating Medicaid as a block grant would allow some changes to provisions to the “second waiver” the federal Centers for Medicare and Medicaid Services allowed. He said he has had issues with that waiver that essentially says after one has been on Healthy Michigan for four years, they must either find coverage on the exchange (should it still exist, now) or pay as much as 7 percent of the cost of the coverage (which could include payments for co-pays and deductibles).

But Shirkey said he did not support “carte blanche removal” of persons on Healthy Michigan with the change in presidential administrations.

Like Fowler, Shirkey said the cost of uncompensated care is “not a small number” that will come out someone’s pocket if more than 600,000 people lose coverage.

This story was published by Gongwer News Service. To subscribe, click on www.gongwer.com