The FInancial Consequences of the Healthy Michigan Program
Sarah Miller
Business Economics
University of Michigan
Robert Kaestner, Luojia Hu, and Ashley Wong.
The Medicaid Expansions and Credit Market Outcomes
Affordable Care Act was one of the largest expansions of public health insurance coverage since the 1960s. One motivation for expanding coverage is to provide financial protection.
- “No longer will illness crush and destroy the savings that[older Americans] have so carefully put away over a lifetime” -President Johnson (Signing of Medicare)
- “That’s what health insurance reform is all about–the peace of mind that if misfortune strikes, you don’t have to lose everything.” - President Obama 2014 State of the Union.
The MEdicaid Expansion and Financial Outcomes
In Michigan, the ACA Medicaid plan is called the "Healthy Michigan Plan" and has enrolled over 600,000 individuals since it was launched in April of 2014.
To conduct this analysis, we partnered with the Michigan Department of Health and Human Services to match HMP enrollees to their credit reports.
- MDHHS provided information on use of health care services, enrollment, income, and demographic characteristics.
- These were matched using a "double blind" matching method with TransUnion credit reports.
HMP and Financial Outcomes
Data:
From HMP: # of hospitalizations and ED visits in first 12 months of enrollment, presence of a chronic illness diagnosis code on an encounter during first 12 months of enrollment, some demographic information.
HMP AND FINANCIAL OUTCOMES
Exclusions:
- Those with state benefit plan in previous year
- Those not matched to a TU credit report
HMP and FInancial Outcomes
Who doesn't have a credit report?
|
|
Not Matched | Matched |
|---|---|---|
| Age | 30.6 | 41.24 |
| Gender=Female | 44% | 51% |
| Hospitalizations | 0.11 | 0.15 |
| ED Visits | 1.00 | 1.19 |
| Chronic Illness | 63.9% | 77.8% |
| Income as % FPL | 30.4% | 41.1% |
| N | 47,760 | 429,240 |
HealthY Michigan Enrollees
|
|
Pre-ACA | Post-ACA | p-value (difference) |
|---|---|---|---|
| Amount in Collections | $1839.14 | $1489.76 | p < 0.001 |
| Medical Collections | $906.88 | $850.87 | 0.006 |
| Amount past due | $845.13 | $710.47
|
0.008 |
| # Public Records per person | 0.44 | 0.39
|
0.012 |
| # Bankruptcies per person | 0.10 | 0.08
|
0.048 |
Healthy Michigan Enrollees
|
|
|
|---|---|
| Matched to TU credit report | 98.1% |
| Age | 38.78 |
| Gender=Female | 57% |
| Income as % FPL | 38.78 |
| Hospitalizations | 0.14 |
| ED Visits | 0.96 |
| Chronic Illness | 70% |
| # of Individuals: | 322,305 |
All Third Party Collections
End of period effect: -$537.9 (50.38), p<0.001
Medical Collections
End of period effect: -$515 (35.5) p < 0.001
Amount Past Due
End of the period effect: -$233.2 (43.25) p<0.001
Public Records
(Evictions, Bankruptcies, Judgments)
End of the period effect: -0.0672 (0.008) p < 0.001
Bankruptcies
Effect by end of period: -0.001 (0.0008) p < 0.001
Hospitalized/ED In First Year
vs. No Hospitalization/ED
Chronic Illness Vs. No Chronic Illness
Medicaid Only Source of Payment vs. Some TPL
Results
Main takeaway:
- Reductions in delinquencies, bills in collection, and extreme credit events like bankruptcies and public records.
- Beneficiaries who appear most disadvantaged (in terms of health) appear to benefit more.
- These effects are big, and getting bigger over time.
Thank you for the opportunity to discuss some current work surrounding the ACA Medicaid expansions.
Special thanks to:
MDHHS
Sarah Clark
Lisa Cohn
Dave Fogata (TransUnion)