Michigan’s expansion of health coverage for the poor and near-poor holds lessons for other states that are still on the fence about expanding their own Medicaid programs under the Affordable Care Act, a new analysis shows.
In an article in the New England Journal of Medicine, a team of U-M researchers published the first analysis of the initial results from the Healthy Michigan Plan, which launched this past April. The analysis was led by Dr. John Ayanian, School of Public Health professor of health management and policy and director of the U-M Institute for Healthcare Policy and Innovation.
In its first 100 days, the authors write, the plan enrolled 327,912 people with incomes below or just above the poverty level – beating projections for its entire first year. Almost 80 percent of them had not been enrolled in other state health programs for the poor. And 36 percent of those enrolled in the first two months had used their insurance to visit a doctor or clinic by the end of the fourth month.
He and his co-authors propose a national effort to link states, universities, and research groups to perform such evaluations, and inform policymakers’ future decisions about health care reform.
“For other states that more recently decided to expand Medicaid or are still considering this option, our initial analysis demonstrates that with appropriate planning expansion can go smoothly, and that ‘red’ states can launch an expansion with state-specified modifications, if that’s what is required to build political support,” says Dr. Ayanian, who led the team of three U-M researchers to analyze Healthy Michigan Plan data. “The rapid enrollment demonstrates both the ability of the state to launch the program effectively, and the pent-up demand for insurance among low income adults in Michigan.”
“A lot of low-income adults stand to benefit, so we need to look fully at expansion’s impact in every state where it’s occurring, and the impact in states that choose not to expand,” he says.
The researchers describe many of the factors that may have helped Michigan’s expansion progress so quickly and enroll people in every one of the state’s 83 far-flung counties, both rural and urban. Though their paper only covers the first 100 days, enrollment has continued at a steady clip, with 424,852 Michiganders enrolled as of October 20.
Although the expansion received state and federal approvals in late 2013, the enrollment period did not begin until April, several months after residents of other Medicaid-expanding states had already begun to enroll in health plans via state and federal websites including HealthCare.gov.
The massive media coverage of initial problems with the national enrollment site, and the mandate for most Americans to get insurance or pay a tax penalty, may have worked in Michigan’s favor, the authors say. By the time enrollment in the Healthy Michigan Plan began, public awareness was high, which may have contributed to the rapid pace of enrollment in the first 100 days.