Medicaid Expansion Research at U-M

Medicaid Expansion Research at U-M


Impact of Medicaid Expansion on Cardiac Surgery Volume and Outcomes

Likosky, D.S., Sukul, D., Seth, M., He, C., Gurm, H.S., Prager, R.L. (2018). Association between Medicaid expansion and cardiovascular interventions in Michigan. Journal of the American College of Cardiology, 71(9), 1050-1051.

  • Medicaid expansion in Michigan was associated with increased access (volume of services) and equivalent quality for patients receiving cardiovascular revascularization. 

Charles, E.J., Johnston, L.E., Herbert, M.A., Mehaffey, J.H., Yount, K.W., Likosky, D.S., Theurer, P.F., Fonner, C.E., Rich, J.B., Speir, A.M., Ailawadi, G., Prager, R.L., Kron, I.L. (2017). Impact of Medicaid expansion on cardiac surgery volume and outcomes. Annals of Thoracic Surgery., 104(4), 1251-1258.

  • Medicaid expansion in Michigan as compared to Virginia, a nonexpansion state, was associated with fewer uninsured cardiac surgery patients and improved predicted risk scores and morbidity rates.

Employment Status and Health Characteristics of Medicaid Expansion Enrollees

Tipirneni, R., Goold, S.D., Ayanian, J.Z. (2017). Employment status and health characteristics of adults with expanded Medicaid coverage in Michigan. JAMA Internal Medicine.

  • Nearly half of enrollees in the Healthy Michigan Plan reported being employed or self-employed full or part time.
  • About 1 in 4 enrollees said they were out of work. About I in 10 enrollees said they were unable to work. Most of those unable to work reported significant barriers to employment. such as poor health, chronic conditions, older age, or functional limitations.

Economic Effects of Medicaid Expansion in Michigan

Ayanian, J.Z., Ehrlich, G.M., Grimes, D.R., & Levy, H. (2017). Economic effects of Medicaid expansion in Michigan. New England Journal of Medicine, 376(5), 407-410.

  • Additional employment associated with federal Medicaid expansion spending peaked at over 39,000 jobs in 2016 and is projected to support approximately 30,000 jobs in 2021.
  • Increased personal income associated with new employment in Michigan is expected to be relatively stable, at $2.2 billion to 2.4 billion per year.
  • Added economic activity is projected to yield $145-$153 million/year in new state tax revenue.

Medicaid Acceptance & Appointment Availability in Primary Care Practices

Tipirneni, R., Rhodes, K.V., Hayward, R.A., Lichtenstein, R.L., Choi, H., Arntson, E.K., Landgraf, J.M., & Davis, M.M. (2017). Geographic variation in Medicaid acceptance across Michigan primary care practices in the era of the Affordable Care Act. Medical Care Research and Review, 1-18.

  • Geographic regions with lower baseline (<50%) Medicaid acceptance had significant increases in Medicaid acceptance at 4 and 8 months post-expansion, while regions with higher baseline (≥50%) Medicaid acceptance did not experience significant changes in Medicaid acceptance.

Tipirneni, R., Rhodes, K.V., Hayward, R.A., Lichtenstein, R.L., Choi, H., Reamer, E.N., & Davis, M.M. (2016). Primary care appointment availability, wait times, and the importance of non-physician providers during the first year of Medicaid expansion under the Affordable Care Act. American Journal of Managed Care, 22(6), 427-431.

  • Medicaid appointment availability that had increased at 4 months remained increased 1 year after expansion.
  • More appointments were scheduled with non-physician providers over time.

Tipirneni, R., Rhodes, K.V., Hayward, R.A., Lichtenstein, R.L., Reamer, E.N., & Davis, M.M. (2015). Primary care appointment availability for new Medicaid patients increased after Medicaid expansion in Michigan. Health Affairs, 34(8), 1399-1406.

  • Appointment availability increased 6 percentage points for new Medicaid patients and decreased 2 percentage points for new privately insured patients following Medicaid expansion.
  • Wait times remained stable at 1–2 weeks for both groups.

Changes in Insurance Coverage Among Hospitalized Non-elderly Adults

Davis, M.M., Gebremariam, A., & Ayanian, J.Z. (2016). Changes in insurance coverage among hospitalized non-elderly adults after Medicaid expansion in Michigan. Journal of the American Medical Association, 315(23), 2617-2618.

  • With implementation of the Healthy Michigan Plan, the proportion of hospitalized non-elderly adult patients who were uninsured decreased 4 percentage points and the proportion with Medicaid coverage increased 6 percentage points.

Michigan’s Approach to Medicaid Expansion and Reform

Ayanian, J.Z., Clark, S.J., & Tipirneni, R. (2014). Launching the Healthy Michigan Plan – The first 100 days. New England Journal of Medicine, 371(17), 1573-1575.

  • The Healthy Michigan Plan launched on April 1, 2014 and reached its projected enrollment for 2014 within the first 100 days. Several factors contributed to rapid early enrollment.
  • Outlines policy questions that Michigan is addressing that may also be relevant to other states that have expanded Medicaid or are considering doing so.

Ayanian, J.Z., (2013). Michigan’s approach to Medicaid expansion and reform. New England Journal of Medicine, 369(19), 1773-1775.

  • By linking Michigan’s Medicaid expansion to market-oriented changes to the program, the governor and legislature created a pragmatic path to link Republican and Democratic health care priorities.
  • Outlines five core principles in Michigan’s approach to expand Medicaid under the ACA, including: 1) the state must achieve sufficient savings to offset its contributions for the Medicaid expansion when federal funding drops; 2) financial incentives for program enrollees to control their use of health care services and maintain healthy behaviors; 3) use of Medicaid managed care plans rather than fee-for-service; 4) requirement that enrollees have access to primary care and preventive services; and 5) opportunities to enhance the state’s capacity to monitor the costs and quality of health care.

IHPI Member Publications on Medicaid Expansion Nationally

Miller, S. & Wherry, L. R. (2017). Health and access to care during the first 2 years of the ACA Medicaid expansions. New England Journal of Medicine, 36(10), 947-956.

Nikpay, S., Freedman, S., Levy, H., & Buchmueller, T. (2017). Effect of the Affordable Care Act Medicaid expansion on emergency department visits: Evidence from state-level emergency department databases. Annals of Emergency Medicine, 70(2), 215-225.

Desmond, B. S., Laux, M. A., Levin, C. C., Huang, J., & Williams, B. C. (2016). Reasons why individuals remain uninsured under the Affordable Care Act:  Experiences of patients at a student-run free clinic in Michigan, a Medicaid expansion state. Journal of Community Health, 41(2), 417-423.

Hu, L., Kaestner, R., Mazumder, B., Miller, S., & Wong, A. (2016). The effect of the Patient Protection and Affordable Care Act Medicaid expansions on financial well-being. TheNational Bureau of Economic Research.

Kullgren, J. T. (2016). Injecting facts into the heated debates over Medicaid expansion. Annals of Internal Medicine, 164(12), 848-849.

Lipton, B. J., Wherry, L. R., Miller, S., Kenney, G. M., & Decker, S. (2016). Previous Medicaid expansion may have had lasting positive effects on oral health of non-hispanic black children. Health Affairs, 35(12), 2249-2258.

Nikpay, S., Buchmueller, T., & Levy, H. G. (2016). Affordable care act Medicaid expansion reduced uninsured hospital stays in 2014. Health Affairs, 35(1), 106-110.

Wherry, L. R., & Miller, S. (2016). Early coverage, access, utilization, and health effects associated with the Affordable Care Act Medicaid expansions. Annals of Internal Medicine, 164(12), 795-803.

Giladi, A. M., Aliu, O., & Chung, K. C. (2015). The effect of Medicaid expansion on delivery of finger and thumb replantation care to Medicaid beneficiaries and the uninsured. Plastic and Reconstructive Surgery, 138(5), 640e-647e.

Giladi, A. M., Chung, K. C., & Aliu, O. (2015). Changes in use of autologous and prosthetic postmastectomy reconstruction after Medicaid expansion in New York State. Plastic and Reconstructive Surgery, 135(1), 53-62.

Nikpay, S., Buchmueller, T., & Levy, H. (2015). Early Medicaid expansion in Connecticut stemmed the growth in hospital uncompensated care. Health Affairs, 34(7), 1170-1179.

Aliu, O., Auger, K. A., Sun, G. H., Burke, J. F., Cooke, C. R., Chung, K. C., & Hayward, R. A. (2014). The effect of pre-Affordable care act (ACA) Medicaid eligibility expansion in New York State on access to specialty surgical care. Medical Care, 52(9), 790-795.

Giladi, A. M., Aliu, O., Chung, K. C. (2014). The effect of Medicaid expansion in new york state on use of subspecialty surgical procedures by Medicaid beneficiaries and the uninsured. Journal of the American College of Surgeons, 218(5), 889-897.

Jones, D. K., Singer, P. M., & Ayanian, J. Z. (2014). The changing landscape of Medicaid practical and political considerations for expansion. Journal of the American Medical Association, 311(19), 1964-1966.

Waits, S. A., Reames, B. N., Sheetz, K. H., Englesbe, M. J., & Campbell, D. A. (2014). Anticipating the effects of Medicaid expansion on surgery care. JAMA Surgery, 149(7), 745-747.

Lyon, S. M., Douglas, I. S., Cooke, C. R. (2014). Medicaid expansion under the affordable care act: Implications for insurance-related disparities in pulmonary, critical care, and sleep. Annals of the American Thoracic Society, 11(4), 661-667.

Chang, T., & Davis, M. M. (2013).Potential adult Medicaid beneficiaries under the patient protection and Affordable Care Act compared with current adult Medicaid beneficiaries. Annals of Family Medicine, 11(5), 406-411.