Affordable Care Act, healthcare, Obamacare — October 29, 2014 at 4:15 pm

Want Medicaid expansion in your state? Vote accordingly


Study released by the University of Michigan shows how Michigan may set an example for other states.

It’s not news that Medicaid expansion has been a much more popular aspect of the Affordable Care Act (ACA) in states with largely Democratic leadership than in states with more Republicans in charge. But research recently released by the University of Michigan (U-M) shows that customizing the program may make it easier to cut through political red tape — even in “red” states.

More on the details of the study in a moment. But first, my takeaway: If you want Medicaid expansion in your state, vote accordingly. That means voting for Democrats or moderate Republicans who support Medicaid expansion, and electing a legislature that has a balance of Democrats and Republicans that can actually find common ground.

Now, for the study results. In an article in the New England Journal of Medicine, a team of University of Michigan Medical School researchers published the first analysis of the initial results from the Healthy Michigan Plan — Michigan’s version of Medicaid expansion — which launched in April 2014.

The authors wrote that in its first 100 days, the plan enrolled 327,912 people with incomes below or just above the poverty level — surpassing the target for its entire first year. Almost 80 percent of these Michiganders hadn’t 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.

Analysis by the authors says there are lessons here for other states that are still on the fence about expanding their own Medicaid programs under the ACA, since the Healthy Michigan Plan was put in place at a time when both the governor and the majority of the state legislature were Republican.

From John Ayanian, M.D., M.P.P., director of the U-M Institute for Healthcare Policy and Innovation, who led the team of three U-M researchers:

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. …

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.

Some of the customized aspects of the Healthy Michigan Plan that were allowed under a waiver granted by the Centers for Medicare and Medicaid Services hadn’t launched during the research study so they haven’t been analyzed yet. But according to Ayanian, these customizations — such as MI Health Accounts (similar to health savings accounts) and premium-reducing incentives for completing a health risk survey and taking steps to reduce health risks such as quitting smoking — are what made the plan politically feasible in a “red” state.

The researchers add that there’s more research to be done on just how well the Healthy Michigan Plan will deliver positive health outcomes and cost savings by the state over time.

In the short-term, though, it’s important to note that compromise can be reached. As one of the members of Team Eclectablog who covered this story from the beginning — watching Republicans in the Michigan Legislature drag their feet on passing the Healthy Michigan Plan (when they weren’t trying to shoot down Medicaid expansion entirely) — I’ll say that it could have been a lot easier.

Governor Rick Snyder, who supported the Healthy Michigan Plan, could have done much, much more to get the Legislation passed quickly and with immediate effect, which would have allowed the program to begin January 1, 2014. More Michiganders could have gotten care sooner and Michigan would not have missed out on $630 million in federal funding.

But the fact remains that Michigan did manage to get the job done. Now just imagine how much easier and more cost-effective it would have been with a bipartisan legislature or a governor who insisted the legislature finish their work before going on vacation or had taken steps suggested by Democrats to give the law immediate effect.

Whatever state you live in, consider this when you cast your ballot on November 4th. States can do a lot more good when they’re governed with bipartisanship and balance.

If you live in Michigan and want to learn more about the Healthy Michigan Plan, check out the website. Enrollment is open year-round.

You can read the NEJM article HERE (pdf). A podcast of Dr. Ayanian discussing the first 100 Days of the Healthy Michigan Plan is available online.

[Image from the NC Aids Action Network via Flickr.]