SPH Researcher Co-Authors Report Lauding Michigan’s Medicaid Expansion.

Michigan’s success in implementing Medicaid expansion can be a model for other states with bipartisan or Republican-led governments, according to a new report by the Center for Healthcare Research & Transformation (CHRT) that was co-authored by a BU School of Public Health researcher.

David K. Jones, assistant professor of health policy & management and a graduate of the University of Michigan School of Public Health, along with co-authors, examined Michigan’s decision to expand its Medicaid program and join the federal insurance marketplace. As of Nov. 1, nearly 450,000 people had enrolled in the Healthy Michigan Plan—Michigan’s expanded Medicaid program—and another 272,000 had selected coverage through the federally facilitated marketplace. The coverage expansions “have exceeded all projections at the state and federal levels,” the report says.

“This is the direct result of the coming together of key leaders representing a breadth of sectors in Michigan,” according to the report. It cites three key factors: the Republican governor’s interest in pursuing the expansion, the support of a bipartisan coalition, and the inclusion of two federal waiver requirements.

“The number of Republican governorships retained—and gained—during the midterm elections makes Michigan’s experience in securing the Medicaid program’s expansion through the Healthy Michigan Plan particularly important,” said Marianne Udow-Phillips, director of CHRT, based at the University of Michigan.

Governor Rick Snyder led the efforts of both the Medicaid expansion and marketplace enrollment by establishing a leadership team that worked with legislative leaders to shepherd the coverage changes, the report says. Waivers included in the legislation were key to securing the legislature’s approval because they included features such as beneficiary cost sharing and health savings account requirements, according to the authors.

Michigan was one of more than 30 states to default to a federally run exchange, instead of creating its own. The state decided to adopt the Medicaid expansion, but with a delayed start date of April 2014.

The CHRT projects that in 2014, Michigan will have approximately 864,000 uninsured, down from 1.14 million in 2011.

The authors noted that there is still “considerable confusion on the part of consumers about health plans that were cancelled; taxes and fees that are included in new health plans; and the complexity and design of health plans, including the balance between premiums, cost sharing, and provider networks. All these issues will take some time to sort out.”

The report is the most recent in a series of state and regional studies examining the rollout of the ACA. A national network of researchers is examining the ACA under the direction of the Rockefeller Institute of Government at the State University of New York, the Brookings Institution, and the Fels Institute of Government at the University of Pennsylvania.

CHRT’s report on ACA implementation in Michigan and other reports published to date are available on the Rockefeller Institute of Government’s ACA Implementation Research Network: http://www.rockinst.org/ACA/