Renuka Tipirneni1,2, Jeffrey T Kullgren3,4,5,6, John Z Ayanian3,4,7,8, Edith C Kieffer3,9, Ann-Marie Rosland10,11, Tammy Chang3,12, Adrianne N Haggins3,13, Sarah J Clark3,14, Sunghee Lee3,15, Erica Solway3, Matthias A Kirch3, Christina Mrukowicz3, Erin Beathard3, Erin Sears3,5, Susan D Goold3,4,5,7. 1. Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA. rtipirne@med.umich.edu. 2. Division of General Medicine, Department of Internal Medicine , University of Michigan, Ann Arbor, MI, USA. rtipirne@med.umich.edu. 3. Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA. 4. Division of General Medicine, Department of Internal Medicine , University of Michigan, Ann Arbor, MI, USA. 5. Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA. 6. VA Ann Arbor Center for Clinical Management Research, University of Michigan, Ann Arbor, MI, USA. 7. School of Public Health, University of Michigan, Ann Arbor, MI, USA. 8. Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, MI, USA. 9. School of Social Work, University of Michigan, Ann Arbor, MI, USA. 10. Department of Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA. 11. VA Pittsburgh Center for Health Equity Research and Promotion, Pittsburgh, PA, USA. 12. Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA. 13. Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA. 14. Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA. 15. Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.
Abstract
BACKGROUND: Michigan expanded Medicaid under the Affordable Care Act (Healthy Michigan Plan [HMP]) to improve the health of low-income residents and the state's economy. OBJECTIVE: To understand HMP's impact on enrollees' health, ability to work, and ability to seek employment DESIGN: Mixed methods study, including 67 qualitative interviews and 4090 computer-assisted telephone surveys (response rate 53.7%) PARTICIPANTS: Non-elderly adult HMP enrollees MAIN MEASURES: Changes in health status, ability to work, and ability to seek employment KEY RESULTS: Half (47.8%) of respondents reported better physical health, 38.2% better mental health, and 39.5% better dental health since HMP enrollment. Among employed respondents, 69.4% reported HMP helped them do a better job at work. Among out-of-work respondents, 54.5% agreed HMP made them better able to look for a job. Among respondents who changed jobs, 36.9% agreed HMP helped them get a better job. In adjusted analyses, improved health was associated with the ability to do a better job at work (aOR 4.08, 95% CI 3.11-5.35, p < 0.001), seek a job (aOR 2.82, 95% CI 1.93-4.10, p < 0.001), and get a better job (aOR 3.20, 95% CI 1.69-6.09, p < 0.001), but not with employment status (aOR 1.08, 95% CI 0.89-1.30, p = 0.44). In interviews, several HMP enrollees attributed their ability to get or maintain employment to improved physical, mental, and dental health because of services covered by HMP. Remaining barriers to work cited by enrollees included older age, disability, illness, and caregiving responsibilities. CONCLUSIONS: Many low-income HMP enrollees reported improved health, ability to work, and job seeking after obtaining health insurance through Medicaid expansion.
BACKGROUND: Michigan expanded Medicaid under the Affordable Care Act (Healthy Michigan Plan [HMP]) to improve the health of low-income residents and the state's economy. OBJECTIVE: To understand HMP's impact on enrollees' health, ability to work, and ability to seek employment DESIGN: Mixed methods study, including 67 qualitative interviews and 4090 computer-assisted telephone surveys (response rate 53.7%) PARTICIPANTS: Non-elderly adult HMP enrollees MAIN MEASURES: Changes in health status, ability to work, and ability to seek employment KEY RESULTS: Half (47.8%) of respondents reported better physical health, 38.2% better mental health, and 39.5% better dental health since HMP enrollment. Among employed respondents, 69.4% reported HMP helped them do a better job at work. Among out-of-work respondents, 54.5% agreed HMP made them better able to look for a job. Among respondents who changed jobs, 36.9% agreed HMP helped them get a better job. In adjusted analyses, improved health was associated with the ability to do a better job at work (aOR 4.08, 95% CI 3.11-5.35, p < 0.001), seek a job (aOR 2.82, 95% CI 1.93-4.10, p < 0.001), and get a better job (aOR 3.20, 95% CI 1.69-6.09, p < 0.001), but not with employment status (aOR 1.08, 95% CI 0.89-1.30, p = 0.44). In interviews, several HMP enrollees attributed their ability to get or maintain employment to improved physical, mental, and dental health because of services covered by HMP. Remaining barriers to work cited by enrollees included older age, disability, illness, and caregiving responsibilities. CONCLUSIONS: Many low-income HMP enrollees reported improved health, ability to work, and job seeking after obtaining health insurance through Medicaid expansion.
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