Examination of Changes in Health Status Among Michigan Medicaid Expansion Enrollees From 2016 to 2017 | Geriatrics | JAMA Network Open | JAMA Network
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2.
Lee  H, Porell  FW.  The effect of the Affordable Care Act Medicaid expansion on disparities in access to care and health status.  Published online October 26, 2018.  Med Care Res Rev. doi:10.1177/1077558718808709 PubMedGoogle Scholar
3.
Miller  S, Wherry  LR.  Health and access to care during the first 2 years of the ACA Medicaid expansions.   N Engl J Med. 2017;376(10):947-956. doi:10.1056/NEJMsa1612890 PubMedGoogle ScholarCrossref
4.
Wherry  LR, Miller  S.  Early coverage, access, utilization, and health effects associated with the Affordable Care Act Medicaid expansions: a quasi-experimental study.   Ann Intern Med. 2016;164(12):795-803. doi:10.7326/M15-2234 PubMedGoogle ScholarCrossref
5.
Courtemanche  C, Marton  J, Ukert  B, Yelowitz  A, Zapata  D, Fazlul  I.  The three-year impact of the Affordable Care Act on disparities in insurance coverage.   Health Serv Res. 2019;54(suppl 1):307-316. doi:10.1111/1475-6773.13077 PubMedGoogle ScholarCrossref
6.
Buchmueller  TC, Levinson  ZM, Levy  HG, Wolfe  BL.  Effect of the Affordable Care Act on racial and ethnic disparities in health insurance coverage.   Am J Public Health. 2016;106(8):1416-1421. doi:10.2105/AJPH.2016.303155 PubMedGoogle ScholarCrossref
7.
Rtiga S, Orgera K, Damico A; Kaiser Family Foundation. Changes in health coverage by race and ethnicity since implementation of the ACA, 2010-2018. Posted February 2019. Accessed September 15, 2019. https://www.kff.org/disparities-policy/issue-brief/changes-in-health-coverage-by-race-and-ethnicity-since-the-aca-2010-2018/
8.
McWilliams  JM.  Health consequences of uninsurance among adults in the United States: recent evidence and implications.   Milbank Q. 2009;87(2):443-494. doi:10.1111/j.1468-0009.2009.00564.x PubMedGoogle ScholarCrossref
9.
Sommers  BD, Gawande  AA, Baicker  K.  Health insurance coverage and health: what the recent evidence tells us.   N Engl J Med. 2017;377(6):586-593. doi:10.1056/NEJMsb1706645 PubMedGoogle ScholarCrossref
10.
Rosland  AM, Kieffer  EC, Tipirneni  R,  et al.  Diagnosis and care of chronic health conditions among Medicaid expansion enrollees: a mixed-methods observational study.   J Gen Intern Med. 2019;34(11):2549-2558. doi:10.1007/s11606-019-05323-w PubMedGoogle ScholarCrossref
11.
Sommers  BD, Maylone  B, Blendon  RJ, Orav  EJ, Epstein  AM.  Three-year impacts of the Affordable Care Act: improved medical care and health among low-income adults.   Health Aff (Millwood). 2017;36(6):1119-1128. doi:10.1377/hlthaff.2017.0293 PubMedGoogle ScholarCrossref
12.
Sommers  BD, Blendon  RJ, Orav  EJ, Epstein  AM.  Changes in utilization and health among low-income adults after Medicaid expansion or expanded private insurance.   JAMA Intern Med. 2016;176(10):1501-1509. doi:10.1001/jamainternmed.2016.4419 PubMedGoogle ScholarCrossref
13.
Swaminathan  S, Sommers  BD, Thorsness  R, Mehrotra  R, Lee  Y, Trivedi  AN.  Association of Medicaid expansion with 1-year mortality among patients with end-stage renal disease.   JAMA. 2018;320(21):2242-2250. doi:10.1001/jama.2018.16504 PubMedGoogle ScholarCrossref
14.
Shippee  ND, Vickery  KD. The complex needs of Medicaid Expansion enrollees with very low incomes. Commonwealth Fund. Published May 31, 2018. Accessed September 15, 2019. https://www.commonwealthfund.org/publications/issue-briefs/2018/may/complex-needs-medicaid-expansion-enrollees-very-low-incomes
15.
Winkelman  TNA, Chang  VW.  Medicaid expansion, mental health, and access to care among childless adults with and without chronic conditions.   J Gen Intern Med. 2018;33(3):376-383. doi:10.1007/s11606-017-4217-5 PubMedGoogle ScholarCrossref
16.
Winkelman  TNA, Segel  JE, Davis  MM.  Medicaid enrollment among previously uninsured Americans and associated outcomes by race/ethnicity-United States, 2008-2014.   Health Serv Res. 2019;54(suppl 1):297-306. doi:10.1111/1475-6773.13085 PubMedGoogle ScholarCrossref
17.
Brown  CC, Tilford  JM, Bird  TM.  Improved health and insurance status among cigarette smokers after Medicaid expansion, 2011-2016.   Public Health Rep. 2018;133(3):294-302. doi:10.1177/0033354918763169 PubMedGoogle ScholarCrossref
18.
Braveman  PA, Cubbin  C, Egerter  S, Williams  DR, Pamuk  E.  Socioeconomic disparities in health in the United States: what the patterns tell us.   Am J Public Health. 2010;100(suppl 1):S186-S196. doi:10.2105/AJPH.2009.166082PubMedGoogle ScholarCrossref
19.
Department of Health and Human Services. Healthy People 2020 website. Updated June 1, 2020. Accessed September 15, 2019. https://www.healthypeople.gov/
20.
Ayanian  JZ.  Michigan’s approach to Medicaid expansion and reform.   N Engl J Med. 2013;369(19):1773-1775. doi:10.1056/NEJMp1310910 PubMedGoogle ScholarCrossref
21.
WK Kellogg Foundation. The business case for racial equity: a strategy for growth. Accessed September 15, 2019. http://www.businesscaseforracialequity.org/resources
22.
Tipirneni  R, Kullgren  JT, Ayanian  JZ,  et al.  Changes in health and ability to work among Medicaid expansion enrollees: a mixed methods study.   J Gen Intern Med. 2019;34(2):272-280. doi:10.1007/s11606-018-4736-8 PubMedGoogle ScholarCrossref
23.
Moniz  MH, Kirch  MA, Solway  E,  et al.  Association of access to family planning services with Medicaid expansion among female enrollees in Michigan.   JAMA Netw Open. 2018;1(4):e181627. doi:10.1001/jamanetworkopen.2018.1627 PubMedGoogle Scholar
24.
The American Association for Public Opinion Research. Standard definitions: final dispositions of case codes and outcome rates for surveys. Revised 2016. Accessed September 4, 2017. http://www.aapor.org/AAPOR_Main/media/publications/Standard-Definitions20169theditionfinal.pdf
25.
Center for Studying Health System Change. Health Tracking Household Survey, 2007 [United States] (ICPSR 26001). Accessed September 15, 2019. https://www.icpsr.umich.edu/icpsrweb/HMCA/studies/26001/version/1
26.
Centers for Disease Control and Prevention (CDC), National Center for Health Statistics. National Health Interview Survey (NHIS): questionnaires, datasets, and related documentation. Reviewed May 6, 2019. Accessed September 15, 2019. https://www.cdc.gov/nchs/nhis/nhis_questionnaires.htm
27.
Centers for Disease Control and Prevention (CDC), National Center for Health Statistics. National Health and Nutrition Examination Survey: NHANES questionnaires, datasets, and related documentation. Reviewed February 21, 2020. Accessed September 15, 2019. https://wwwn.cdc.gov/nchs/nhanes/Default.aspx
28.
Rabe-Hesketh  S, Skrondal  A.  Multilevel modelling of complex survey data.   J R Stat Soc Ser A Stat Soc. 2006;169(4):805-827. doi:10.1111/j.1467-985X.2006.00426.x Google ScholarCrossref
29.
Tipirneni  R, Patel  MR, Goold  SD,  et al.  The association of expanded Medicaid coverage with health and job-related outcomes among enrollees with behavioral health disorders.   Psychiatr Serv. 2020;71(1):4-11. doi:10.1176/appi.ps.201900179PubMedGoogle ScholarCrossref
30.
Sommers  BD, Gunja  MZ, Finegold  K, Musco  T.  Changes in self-reported insurance coverage, access to care, and health under the Affordable Care Act.   JAMA. 2015;314(4):366-374. doi:10.1001/jama.2015.8421 PubMedGoogle ScholarCrossref
31.
Finkelstein  A, Taubman  S, Wright  B,  et al; Oregon Health Study Group.  The Oregon health insurance experiment: evidence from the first year.   Q J Econ. 2012;127(3):1057-1106. doi:10.1093/qje/qjs020 PubMedGoogle ScholarCrossref
32.
Michigan Department of Health and Human Services. State Innovation Model. Accessed September 15, 2019. https://www.michigan.gov/mdhhs/0,5885,7-339-71551_64491---,00.html
33.
Cher  BAY, Morden  NE, Meara  E.  Medicaid expansion and prescription trends: opioids, addiction therapies, and other drugs.   Med Care. 2019;57(3):208-212. doi:10.1097/MLR.0000000000001054 PubMedGoogle ScholarCrossref
34.
Saloner  B, Bandara  S, Bachhuber  M, Barry  CL.  Insurance coverage and treatment use under the Affordable Care Act among adults with mental and substance use disorders.   Psychiatr Serv. 2017;68(6):542-548. doi:10.1176/appi.ps.201600182 PubMedGoogle ScholarCrossref
35.
Miilunpalo  S, Vuori  I, Oja  P, Pasanen  M, Urponen  H.  Self-rated health status as a health measure: the predictive value of self-reported health status on the use of physician services and on mortality in the working-age population.   J Clin Epidemiol. 1997;50(5):517-528. doi:10.1016/S0895-4356(97)00045-0 PubMedGoogle ScholarCrossref
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    Original Investigation
    Health Policy
    July 10, 2020

    Examination of Changes in Health Status Among Michigan Medicaid Expansion Enrollees From 2016 to 2017

    Author Affiliations
    • 1Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor
    • 2Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
    • 3Department of Internal Medicine, University of Michigan, Ann Arbor
    • 4School of Social Work, University of Michigan, Ann Arbor
    • 5US Department of Veterans Affairs VA Ann Arbor Healthcare System, Ann Arbor, Michigan
    • 6Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor
    • 7Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor
    • 8Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor
    • 9Department of Family Medicine, University of Michigan, Ann Arbor
    • 10Institute for Social Research, University of Michigan, Ann Arbor
    • 11Department of Pediatrics, University of Michigan, Ann Arbor
    • 12Friends of Parkside, Detroit, Michigan
    JAMA Netw Open. 2020;3(7):e208776. doi:10.1001/jamanetworkopen.2020.8776
    Key Points español 中文 (chinese)

    Question  What longitudinal changes in self-reported health status and days of poor health among racial, ethnic, urban/rural, and very-low-income subgroups of enrollees are associated with Medicaid expansion?

    Findings  In this survey study of 3097 respondents, reports of fair or poor health and days of poor physical health decreased over time among enrollees, especially among non-Hispanic black enrollees and those with very low incomes. There were no statistically significant differences in the number of days of poor mental health or the number of days of usual activities missed owing to poor physical or mental health over time.

    Meaning  These findings suggest that within Medicaid expansion, the health of vulnerable populations is improving.

    Abstract

    Importance  Evidence about the health benefits of Medicaid expansion has been mixed and has largely come from comparing expansion and nonexpansion states.

    Objective  To examine the self-reported health of enrollees in Michigan’s Medicaid expansion, the Healthy Michigan Plan (HMP), over time.

    Design, Setting, and Participants  A telephone survey from January 1 to October 31, 2016 (response rate, 53.7%), and a follow-up survey from March 1, 2017, to January 31, 2018 (response rate, 83.4%), were conducted in Michigan, which expanded Medicaid in 2014 through a Section 1115 waiver permitting state-specific modifications. Four thousand ninety HMP beneficiaries aged 19 to 64 years with at least 12 months of HMP coverage and at least 9 months in a Medicaid health plan were eligible to participate. Data were analyzed from April 1 to November 30, 2018.

    Main Outcomes and Measures  Surveys measured demographic characteristics and health status. Analyses included weights for sampling probability and nonresponse. Comparisons between 2016 and 2017 included those who responded to both surveys (n = 3097).

    Results  Of the 3097 respondents to the 2017 follow-up survey, 2388 (77.1%) were still enrolled in HMP (current enrollees) and 709 (22.9%) were no longer enrolled when surveyed (former enrollees). Among all follow-up respondents, a weighted 37.5% (95% CI, 35.3%-39.9%) were aged 19 to 34 years, 34.0% (95% CI, 31.8%-36.2%) were aged 35 to 50 years, and 28.5% (95% CI, 26.7%-30.3%) were aged 51 to 64 years; 53.0% (95% CI, 50.8%-55.3%) were female. Respondents who reported fair or poor health decreased from 30.7% (95% CI, 28.7%-32.8%) in 2016 to 27.0% (95% CI, 25.1%-29.0%) in 2017 (adjusted odds ratio [AOR], 0.66 [95% CI, 0.53-0.81]; P < .001), with the largest decreases observed in respondents who were non-Hispanic black (from 31.5% [95% CI, 27.1%-35.9%] in 2016 to 26.0% [95% CI, 21.9%-30.1%] in 2017; P = .009), from the Detroit metropolitan area (from 30.7% [95% CI, 27.0%-34.4%] in 2016 to 24.9% [95% CI, 21.6%-28.3%] in 2017; P = .001), and with an income of 0% to 35% of the federal poverty level (from 37.6% [95% CI, 34.2%-40.9%] in 2016 to 32.3% [95% CI, 29.1%-35.5%] in 2017; P < .001). From 2016 to 2017, the mean number of days of poor physical health in the past month decreased significantly from 6.9 (95% CI, 6.5-7.4) to 5.7 (95% CI, 5.3-6.0) (coefficient, −6.10; P < .001), including among current (from 7.0 [95% CI, 6.5-7.5] to 5.6 [95% CI, 5.1-6.0]; P < .001) and former (from 6.8 [95% CI, 5.9-7.7] to 5.8 [95% CI, 5.0-6.7]; P = .02) enrollees, those with 2 or more chronic conditions (from 9.9 [95% CI, 9.3-10.6] to 8.5 [95% CI, 7.8-9.1]; P < .001), across all age groups (19-34 years, from 4.3 [95% CI, 3.7-4.9] to 3.0 [95% CI, 2.5-3.5]; P < .001; 35-50 years, from 8.2 [95% CI, 7.3-9.0] to 6.9 [95% CI, 6.1-7.7]; P = .002; 51-64 years, from 9.0 [95% CI, 8.2-9.8] to 7.6 [95% CI, 6.9-8.3]; P = .001), and among non-Hispanic white (from 7.5 [95% CI, 7.0-8.1] to 6.1 [95% CI, 5.6-6.6]; P < .001) and black (from 5.9 [95% CI, 5.1-6.8] to 4.4 [95% CI, 3.6-5.1]; P < .001) respondents. No changes in days of poor mental health or usual activities missed owing to poor physical or mental health were observed.

    Conclusions and Relevance  These findings suggest that HMP enrollees in Michigan have experienced improvements in self-reported health over time, including minority groups with a history of health disparities and enrollees with chronic health conditions.

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