Michigan’s Medicaid Expansion Leads to Lower Uninsured Rates, Improved Health, and Cost Savings


This article is part of Health, a series on how Michigan communities are rising to meet health challenges. It is made possible by funding from the Michigan Health Endowment Fund.

Since the state of Michigan created the Healthy Michigan Plan in 2014, expanding Medicaid coverage to all households with incomes reaching 133% of the federal poverty line, the number of uninsured Michiganders has increased. 53% drop. Now, with help from the University of Michigan (UM), the state is looking back to examine how this change has improved the health of Michigan residents who otherwise could not afford health insurance.

The Michigan Department of Health and Human Services (MDHHS) enlisted the UM Institute for Health Policy and Innovation (IHPI) to study the impacts of the Healthy Michigan Plan. Created under the Affordable Care Act, the Healthy Michigan Plan is a type of Medicaid coverage run by MDHHS which provides health insurance coverage to Michigan residents, aged 19 to 64 with income at or below 133% of the federal poverty line, who are not eligible for Health Insurance or other Medicaid programs. This means that over the past seven years, a family of four earning about $ 36,500 or less could access health insurance through Medicaid or the Healthy Michigan Plan. By July 2020, 749,547 Michigan residents have been enrolled in the Healthy Michigan plan.
Dr. Susan Goold and Dr. Renuka Tipirneni worked on the University of Michigan’s assessment of the expansion of Medicaid in Michigan.
IHPI’s work found that as a result of the expansion, more Michiganders are receiving primary and preventive health care, managing their chronic conditions more effectively, and seeking care in their own health care homes rather than in emergency rooms and walk-in emergency care clinics.
Brian Keisling.
“As for what Healthy Michigan Plan enrollees reported to the University of Michigan when they were interviewed, they saw the detection of chronic conditions and were able to get treatment for them,” says Brian. Keisling, director of the Office of Medicaid Operations and Actuarial Services for the Medicaid program at MDHHS Michigan. “They also, in terms of their own perception, saw an improvement in their health and their treatment of chronic diseases.”

Michigan residents of all races and ethnicities responding to IHPI surveys say their health has improved and they now have access to regular care through a doctor’s office. These improvements were most notable among low-income residents.

“Improving the health of a population over time typically takes years and years, not two or three,” says Dr Susan Goold, professor of internal medicine and health management and policy at the ‘UM and author of a recent study on the impact of the expansion. “Just to see improvements in the health of the Medicaid population over the span of a few years is impressive.”

Before enrolling in the Healthy Michigan Plan, 49% of study participants had a regular doctor’s office, 25% had no regular source of medical care, and 23% reported using walk-in care and wards. emergency when they needed care. Black and Latino respondents were more likely to use walk-in care, while White and Arab American / Chaldean respondents were more likely not to have a regular source of care. In 2018, 83% of those enrolled in the Healthy Michigan Plan reported having created a healthcare home.

“Michigan has really put a lot of emphasis on primary care and the use of preventative services,” Goold said. “If you can imagine being a low-income person, the last thing you want to pay for is a colonoscopy. Low-income people usually don’t go to the doctor until they’re sick.”
Dr Susan Goold.
In terms of general health, the overall percentage of respondents reporting fair or poor health rose from 30% in 2016 to 25% in 2018. However, the number of Latinx respondents fell further from 30%. % to 18%; as well as black respondents, who fell from 33% to 25%.

“When we talk about health equity, we are looking for ways to ensure that everyone has what they need to access health care and general well-being. With the expansion of Medicaid, we are seeing an increase in preventive care, important health examinations, ”says Amber Bellazaire, health policy analyst at Michigan League for Public Policy (MLPP). “There is no doubt that the Healthy Michigan Plan has played a role in increasing health equity. Coverage alone is not going to eliminate all of the disparities that we see, but it is absolutely a critical factor. “

While experts can only guess how the COVID-19 pandemic would have impacted nearly one million Michiganders who would not have had health insurance without the Healthy Michigan Plan, the most likely results would have been even darker. The number of residents enrolled in the program increased from 650,000 to 900,000 during the pandemic.

Amber Bellazaire.For some, the pandemic meant decreased income due to job loss. Adults who lost their employer-sponsored coverage did not become uninsured but instead had the Healthy Michigan plan to turn to. when they needed it, ”Bellazaire said. “Plus, Medicaid couldn’t unenroll people during the emergency. This was very helpful so that those enrolled didn’t have to worry about changes to their coverage or dealing with renewal processes at height. of the pandemic. “

State-level leaders, especially those leading the MDHHS programs, have been delighted with the positive impacts that the expansion of Medicaid has had in Michigan.

“This goes a long way in reducing the total number of uninsured people,” Keisling said. “Before the expansion of Medicaid, historically we had about 1.2 million people without insurance. The Healthy Michigan Plan dramatically reduces that number.”

Keisling says more and more people are using primary care and controlling chronic illnesses before they get worse and more expensive.

“They can see their primary care doctor and others as needed to help them manage these issues and not let them get out of hand,” Keisling said. “And certainly, it improves the financial health of individuals, because we know that they don’t have to actively spend the resources they have to obtain health coverage for themselves.”

When people with limited incomes don’t end up in the emergency room or hospitalized, hospitals also save money. There is no projected net cost to the Crown over the next 21 years – while saving a $ 320 million project uncompensated health care costs by 2022 only. Federal funds covered 100% of the cost from 2014 to 2016, 95% in 2017, 94% in 2018, 93% in 2019, and 90% in 2020 and beyond. While the state covers these costs not covered by federal dollars, the expansion of Medicaid in Michigan has also added about 30,000 new jobs, increase in personal income for residents by $ 2.3 billion and savings of $ 235 million for the state in 2016 alone, as federal Medicaid funds covered some prison health care costs.

“Our assessment of Medicaid’s overall expansion revealed many benefits to the state, not just for Medicaid registrants but for hospitals. Unpaid care has declined, especially in rural areas, and it can be. very important, ”Goold said. “People with health insurance are more likely to have a job. It doesn’t just help registrants. It helps a lot of other people: those who care for them, health care providers and their caregivers. The expansion of Medicaid has been a real plus for the state. “

A freelance writer and writer Estelle Slootmaker is happiest writing about social justice, wellness and the arts. She is the development news editor for Fast growing medium and L’Arbre Amigos chairs, Wyoming City Tree Commission. His greatest achievement is his five incredible adult children. You can contact Estelle at [email protected] or www.constellations.biz.

All photos are by Doug Coombe.


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