LANSING – Despite the enrollment period being cut to just 45 days and cutbacks in federal promotion efforts, the number of Michigan residents who signed up for health insurance through federal Patient Protection and Affordable Care Act was nearly 300,000, which shows the controversial law remains a viable option for many persons, one health care expert said.

But what the state might see in terms of individuals electing not to get coverage, since the U.S. tax code changes signed last week by President Donald Trump discontinue the mandate that all U.S. residents have health insurance or face tax consequences, and the effect that might have on insurers as well is uncertain, said Marianne Udow-Phillips, director of the Center for Healthcare Research and Transformation at the University of Michigan.

The federal Centers for Medicare and Medicaid announced last week that more than 8.8 million residents across the U.S. had signed up for health insurance through the ACA federal exchange. The number was somewhat surprising, given Mr. Trump and Congress’ unsuccessful efforts to end or replace the ACA during 2017, as well as the federal government cutting the enrollment period from 90 days to 45 days, and cutting back on promotional efforts.

In Michigan, 298,999 people signed up for the coverage beginning January 1, 2018. In 2017, the state saw 321,451 people get coverage through the federal exchange. Udow-Phillips said if the enrollment time had equaled previous years the state might have seen more people than in 2017 sign up for the plan.

That coverage through the ACA remains popular shows people want health insurance, Udow-Phillips said, and that, “despite the rhetoric the ACA is still working.” But, she acknowledged, it is working for those that get tax breaks based on their income. For those persons, health care costs are more reasonable.

The middle class, whose incomes might exceed the limit eligible for tax credits, have a more difficult time paying the premiums charged for coverage, Udow-Phillips said.

And they might have an even more difficult time affording coverage once the mandate for coverage ends.

While there are no specific forecasts for the possible effect on Michigan policyholders, the Congressional Budget Office has forecast that as 13 million people might lose coverage over a 10-year period.

Loss of covered individuals could force insurance companies to boost premiums by as much as 10 percent, she said. And if any companies drop out of covering health care because of the potential instability of the market that could boost premiums further.

“The people who will get hurt are the middle-class,” Udow-Phillips said.

The end of the mandate is unlikely to have much effect on those that enroll for health care coverage under the Healthy Michigan Medicaid expansion plan, however. Geralyn Lasher with the Department of Health and Human Services said the mandate would most likely affect persons who are in a higher income range than those eligible for the Healthy Michigan plan. That plan provides coverage to individuals whose incomes are up to 133 percent of the federal poverty level.

But Udow-Phillips said the debates on health care over the past year, plus the possible effects the tax changes could have on coverage and other issues – such as what might happen with the Children’s Health Insurance Plan – could mean that health care looms as a big political issue in the 2018 election.

This story was published in Gongwer News Service.