On July 18, IHPI Director John Z. Ayanian, M.D., M.P.P. took part in a meeting organized by Altarum's Center for Sustainable Healthcare Spending, titled "Beyond the ACA: Health Policy and Sustainable Health Spending".
His talk, about the state of Michigan's experience with Medicaid expansion, shared results from IHPI's evaluation of the impact of the Healthy Michigan Plan, and other research related to Medicaid expansion.
"In Michigan we've seen about 650,000 low-income adults gain coverage," he noted. "About 40 to 50 percent of new enrollees report that their physical, mental or dental health has improved within the first year of enrollment."
He also laid out key findings about the decline in uncompensated care and uninsured discharges at hospitals across the state after Medicaid expansion. And, he shared results from an economic model that found that nearly 40,000 jobs, additional state tax revenue and reduced state and personal spending could be attributed to the Medicaid expansion in 2016 alone.
"The challenge now as we think about repealing, replacing or reconstituting the Affordable Care Act," he explained, is that "there are many people who are benefiting in terms of their access to care, their out-of-pocket costs and their health outcomes when they're getting the right care, and I think that's what we need to focus on. How do we preserve some of the benefits as we try to correct some of the concerns that politicians across the spectrum have about the Affordable Care Act is functioning."
Going forward, he said, "We need to think not 'Is it about coverage or about cost control' -- it's about both. We need to separate the immediate short-term fixes we need for the Marketplaces to get them functioning effectively, and the much longer-term fixes we need for Medicaid. Those two major parts of the ACA both could be potentially improved."
Ayanian also commented on the potential future for incentives to help bend the "cost curve" for healthcare spending in the United States, calling for greater flexibility for states and provider networks to achieve targets set by the federal government and creating more "natural experiments" to determine what might work better than the current fee-for-service system.