Tammy Chang, M.D., M.P.H., M.S., assistant professor, is among the authors of a new study conducted by the University of Michigan’s Institute for Health Policy and Innovation, on the early health impact of Michigan’s Medicaid expansion program, the Healthy Michigan plan.
Five states will expand Medicaid in 2019. Fourteen may start requiring Medicaid enrollees to work in return for their health coverage. And a new study could help all of these states understand what might be in store under these policies.
The study finds that nearly half of people covered by Michigan’s expanded Medicaid program reported their physical health improved in the first year or two after they enrolled in the program. More than a third said their mental or dental health had improved.
These self-reported improvements in health occurred earlier than had been seen in studies in other states.
Meanwhile, nearly half of those surveyed were working, though they earned less than the near-poverty-level wages needed to qualify for Healthy Michigan Plan coverage. Nearly half of those who reported they were employed also had at least one chronic medical condition.
Impacts on work
Of those who were employed, more than two-thirds said having Healthy Michigan Plan coverage helped them do a better job at work. And more than a third of those who changed jobs in the last year said Healthy Michigan Plan coverage helped them get a better job.
Those who said their health improved due to their new coverage were four times as likely to say that they were doing a better job at work. And those who had a chronic condition were more likely to say that they were doing a better job at work since getting covered.
Another quarter of the respondents were out of work when they took the telephone survey -- yet more than half of them said their Healthy Michigan Plan coverage improved their ability to look for a job. Those who were age 51 and over were especially likely to say this.
Tallying the effects
The study, published in the Journal of General Internal Medicine, is based on a survey of 4,090 people enrolled in Healthy Michigan who answered questions by telephone about their knowledge and experiences with the program and the impact it had on their health and lives.
The paper also includes responses from in-depth interviews with 67 Healthy Michigan Plan enrollees who described in detail the impact of their coverage. They spoke of being able to get care for issues such as back pain, mental health conditions, and oral health problems that had interfered with their ability to work.
“What's interesting is that people reported palpable impacts on their health so quickly -- usually this can take years to happen,” says Renuka Tipirneni, M.D., M.Sc., lead author of the new study and an assistant professor of internal medicine at U-M. “When we looked at that in more detail, what we noticed was that enrollees who reported those health improvements were three to four times more likely to report that they were either better able to do a good job at work or better able to seek a job.”
Eighty percent of those surveyed had incomes below the federal poverty level for their household at the time they took the survey in 2016; this was equivalent to about $12,000 for an individual at the time. The rest had incomes less than 133 percent of the federal poverty level, which varies depending on household size. Even those working close to full-time at minimum wage may qualify for the Healthy Michigan Plan.
Article citation: Tipirneni R, Kullgren JT, Ayanian JZ, Kieffer EC, Rosland A, Chang T, Haggins AN, Clark SJ, Lee S, Solway E, Kirch MA, Mrukowicz C, Beathard E, Sears E, Goold SD. Changes in Health and Ability to Work Among Medicaid Expansion Enrollees: a Mixed Methods Study. Journal of General Internal Medicine. December 2018. doi:10.1007/s11606-018-4736-8.
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