Medicaid expansion enrollees in Michigan increased their rate of employment or student status at a significantly higher rate than the rest of the state's population in 2017, the latest evidence on the benefits of expansion under the Affordable Care Act.
The percentage of expansion enrollees who had jobs or were enrolled in school rose six percentage points in one year, while the rate for other state residents remained flat, according to a new study published in JAMA Network Open.
The survey, conducted by University of Michigan researchers, found that 60% of expansion enrollees were employed or students in 2017, compared with 54% in 2016. Non-Hispanic black enrollees and people whose incomes were less than one-third of the federal poverty level had even larger increases in employment or student status—11 and 9 percentage points, respectively.
By comparison, the general Michigan population had a steady 75% rate of employment or school enrollment from 2016 to 2017.
Experts said the results call into question Michigan's new policy, starting this month, of requiring expansion enrollees to report work or "community engagement" activities as a condition of receiving Medicaid expansion coverage.
They argue that receiving health coverage and needed care puts people in a better position to find jobs or go to school to prepare for work, as opposed to policies threatening to take away their healthcare if they do not get jobs.
"This study suggests states that want to increase employment among low-income adults might consider Medicaid as a way to support people who want to work, rather than seeing Medicaid as a barrier to work," said Dr. Benjamin Sommers, a health policy professor at Harvard University who studies Medicaid.
Trump administration officials and Michigan Republican leaders have argued the opposite—that receiving Medicaid reduces people's motivation to work, and that requiring them to work is the best way to improve their health and wellbeing.
The new JAMA Network Open paper is consistent with a large and growing body of research showing that Medicaid expansion is associated with a wide range of benefits, including increased coverage, service use, quality of care and federal and state Medicaid spending.
The University of Michigan researchers surveyed more than 3,000 low-income adults who qualified for the Healthy Michigan Plan, with a response rate of 53.7% to the initial survey and 83.4% to the follow-up survey.
They found similar employment or school attendance gains for both those still enrolled in Medicaid in 2017 and those no longer enrolled.
People who left Medicaid may already have experienced health improvements and had better ability to get a job, said Dr. Renuka Tipineni, a University of Michigan assistant professor who was the lead author of the study.
"Our hypothesis is that the ability to access care, get diagnoses, and manage chronic conditions has led enrollees to have improved functioning in employment and school attendance," Tipineni said in an interview.
For Michiganders who were extremely poor and who showed sharp increases in employment or school status, receiving Medicaid was especially beneficial, said Leighton Ku, a health policy professor at George Washington University.
"Some may have worried that getting a job might cause them to lose their insurance, since so many low-wage or part-time jobs lack health benefits," he said. "Having Medicaid may help dispel that worry and encourage people to find work."
Earlier this month, Michigan started requiring more than 270,000 of the nearly 524,000 expansion enrollees to file monthly reports on whether they are spending 80 hours a month working or participating in community engagement activities.
If enrollees do not meet the work or reporting requirements, they can lose coverage starting May 1, 2020. A Manatt Health study projected that tens of thousands of Michiganders could lose coverage under the program.
Sommers said the new JAMA Network Open study suggests that "Medicaid itself can increase self-sufficiency without the red tape and administrative hassle of work requirements."
