Kaiser notes success with expanded Medicaid, and waiver risks

By Dennis Archambault

Most people working with people in the health care safety net understood that it would be some time before health indicators among the expanded Medicaid population (Healthy Michigan) would improve through the Affordable Care Act, and that in the short-term, health costs would increase due to increased use of primary care, diagnostic services, and specialty services. As Michigan and other states plan to implement work rules for Healthy Michigan recipients, the Kaiser Family Foundation has released two reports that document health status improvement in this population and that “work” rules will likely affect those who are working the most.

In a report released Aug. 16, the Kaiser Foundation noted that Medicaid expansion has reduced the uninsured rate nationally as well as uncompensated care costs — while increasing affordability and access to care. Health outcomes are beginning to improve, and there are indications that states are saving money (However, it should be noted that this data comes from the period in which the federal government covered expanded Medicaid 100 percent. That will be reduced to 90 percent, thereby increasing costs to states.)

Key findings of the report include:

Some studies show that improved access to care and greater utilization of care is leading to increases in the diagnosis (and early diagnosis) of cancer and other conditions, and to increased prescriptions for medications used to treat opioid use disorder and opioid overdose.

A growing body of research finds an association between Medicaid expansion and certain measures of health outcomes, including improvements in self-reported health as well as improvements in cardiovascular mortality rates and cardiac patient surgery outcomes. Studies also show that Medicaid expansion improves affordability of health care and results in improvements in broader measures of financial stability.

Meanwhile, the Kaiser Foundation also released a report earlier in August that noted that expanded Medicaid supports the highly stressed working poor of the country. For those who contend that Medicaid recipients should have “skin in the game,” they need to get a better idea of how hard life is in this sector. Findings of this study include:

Most Medicaid adults are already working; among those who are not working, most report barriers to work. Those with better health and more education are more likely to be working.

Most Medicaid adults who work are working full-time for the full year but are working in low-wage jobs in industries with low employer-sponsored insurance offer rates. Industries and occupations with the largest number of workers covered by Medicaid often include jobs that are physically demanding, such as food service or construction. Even when working, adults with Medicaid face high rates of financial and food insecurity — as they live in or near poverty levels.

Many Medicaid enrollees face barriers to work, such as functional disabilities, serious medical conditions, school attendance, and care-taking responsibilities. Many Medicaid adults do not use computers, the internet, or email, which could be a barrier in finding a job or complying with policies to report work or exemption status.

People who remain eligible for coverage could lose coverage as a result of reporting requirements and work requirements may not result in increased employment or employer-based health coverage.

Dennis Archambault is vice president of Public Affairs for Authority Health.