Evaluating Michigan's healthcare safety net

Eight years ago this month, Michigan’s political and health leaders came together to expand the health care safety net for low-income Michiganders, by creating the Healthy Michigan Plan. 

Today, nearly 1 in 10 Michiganders — more than 939,000 adults under 65 — get their health insurance through it. All of them have incomes under about $18,000 a year for an individual, or $33,000 for a family of three. 

What impact has this new kind of health coverage had? 

A lot, according to research by the U-M team at the Institute for Healthcare Policy and Innovation that is studying the program for the state. 

They’ve shown it’s had positive effects on the ability of low-income adults to get access to care, detect health problems early, and improve their physical, mental and financial health. 

They’ve also found that most of the low-income Michiganders who enrolled in the program already had jobs or were looking for them, or were students. But they did not have access to affordable health insurance through their jobs or other means. The team’s research shows that for many, getting coverage improved these adults’ ability to work or seek a job. 

These are just a few examples of findings the team has published in reports and papers over the past seven years. Their work helps Michigan’s government understand how well this investment of state and federal dollars is working. 

In fact, one U-M study that was not part of the evaluation showed that the Healthy Michigan Plan program pays for itself through increased economic activity by the people it covers and the health care institutions that serve them.

Just recently, the U-M team got good news: the state and federal government approved their new evaluation design which will guide their continued work on this topic. 

Currently, 18 million Americans receive health care coverage through Medicaid expansion programs, and another 64 million are covered by traditional Medicaid. The U-M work has had an impact far beyond Michigan’s borders, to other states that more recently started similar programs, or are debating it, under the Medicaid Expansion provision of the Affordable Care Act.

Across the country, 2.2 million people might qualify for such programs if they existed in their states. 

The data coming out of the IHPI evaluation is some of the most detailed in the nation. This kind of in-depth work has already revealed opportunities to change and improve the program. For instance, the IHPI team found a need to increase enrollees’ awareness of the availability of preventive health services through their coverage. They’ve also quantified the impact of some of the special features of Michigan’s program, not found in other states, that focus on healthy behaviors and cost sharing.