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    Medicaid expansion in Michigan is currently in full effect. To date, over 405,000 people have been enrolled in the Healthy Michigan Plan, which is the program in Michigan that incorporates the expansion of Medicaid into the overall insurance reforms set by the Affordable Care Act. This figure, when looking at the goal of reaching 477,000 enrollees in Healthy Michigan, is quite impressive with around 85% of those eligible already signed up. This means that nearly 2.2 million adults and children in Michigan will be eligible for Medicaid. From the beginning, the rollout of the Healthy Michigan program seemed to occur without a hitch. The Affordable Care Act was plagued with many problems upon its arrival, namely the difficulty or inability to use the website; therefore the administrators of the rollout in Michigan wanted to ensure that their website and other functions of the system would operate properly and efficiently. Their hopes were met, and when enrollment opened on April 1st of 2014, individuals were able to operate the system with ease. This may be a contributing factor to the exceeded expectations of enrollees experienced by the Michigan Department of Community Health (MDCH). Nick Lyon, the Director of MDCH, was very satisfied with the greater number of individuals who signed up, saying that there must have been a large demand for this program.

    Echoing the positive demeanor of the MDCH Director is Governor Snyder, whose approval of the expansion was the final piece needed to put it into effect. On the campaign trail, Governor Snyder said that Healthy Michigan is the “capstone” of health care policies in our state. With new reforms such as a greater emphasis on infant health and requiring epinephrine pens in public schools, Governor Snyder hailed the initiation of the program. On the other side of the aisle, Democratic gubernatorial candidate Mark Schauer has said that Snyder’s endorsement and implementation of the program was a good step. However, Schauer claimed that the governor was “too late” in approving it, and that the delay cost the state an unnecessary amount of money. Conservatives were quick to criticize the governor for pushing the expansion through as well. Though enough Republicans in the Senate joined their Democratic colleagues to approve the expansion, its start-up was delayed. The Republicans who did not vote on the expansion were unhappy with their Republican colleagues who voted yes. As Republican Senator Jack Brandenburg claimed, this issue is “bigger than right-to-work and it will definitely split our party.” This rhetoric, however, does not seem to be worrying the governor in his re-election bid, as he is hoping to appeal to a broader electorate with his position on the expansion issue.

    So, where does Michigan stand compared to other states on this process? In total, 27 states and Washington, D.C. have complied with federal regulations and expanded their Medicaid programs. At this time, three more states are considering. Looking at party demographics, Governor Snyder joins five other Republican governors in expanding their states programs. The rest of the states are controlled by Democratic governors. Many other states with Republican controlled executive and legislative branches have taken firm stances against rolling out an expansion program for Medicaid. However, there are some cases where Republican controlled state governments, like ours, have approved expansion, but in a unique and somewhat questionable manner. In Ohio, Republican Governor Kasich circumvented his Republican controlled legislature to enact their new Medicaid program. Compared to Michigan, where at least some Republicans in the state legislature supported the expansion, Ohio’s Republicans are very unhappy with their governor.

    It can easily be said that for the majority of Republican controlled states, the expansion of Medicaid was not met well. Even in the Republican states that approved the expansion, like Michigan and Ohio, many GOP politicians fiercely opposed its enactment. In our state specifically, those Republicans who vehemently opposed it were unable to stop its formulation into law. Now, the program is in full swing, with more and more people signing up for it each day. Will this negatively affect the governor or legislators on both sides of the aisle in the 2014 midterms? It is hard to say, but one thing that is for sure, Medicaid expansion will surely have a tremendous impact.

    Though the election may be impacted by the initiating of Medicaid expansion, it is hard to quantify the affect the expansion is having on those who qualify. To give some idea on how the new program may look, researchers in Oregon examined the state’s limited 2008 expansion. Over the course of two years, the study followed some 30,000 individuals who were chosen by a lottery-style system who were now eligible to receive Medicaid benefits. Certain constraints on this study did present themselves, such as a limited amount of time observing the individuals, and those involved being a select minority of the population of Oregon. However, these limitations did not largely detract from the findings of the research. With the increased coverage, health care was increasingly utilized by those who previously could not afford to do so. Coinciding with this, financial strain on individuals and families was reduced, and financial ruin due to a serious illness or injury was nearly eliminated from this subset of people. Cholesterol, high blood pressure, and glycated hemoglobin levels of did not seem to be affected in individuals who received Medicaid coverage. However, mental health improvements were observed. Though there were limitations on the Oregon Medicaid lottery study, this could give an indication as to what can be expected from Medicaid expansion at a state-by-state level.

    References

    http://acasignups.net/14/09/25/michigan-aca-medicaid-expansion-400k-84-total-eligible http://www.advisory.com/daily-briefing/resources/primers/medicaidmap#lightbox/1/ http://www.medicaid.gov/AffordableCareAct/Medicaid-Moving-Forward-2014/Downloads/FINAL-July-Medicaid-Applications-Eligibility-Enrollment-Report-2.pdf http://www.mlive.com/lansing-news/index.ssf/2014/10/new_department_of_community_he.html http://www.mlive.com/lansing-news/index.ssf/2014/03/officials_michigan_ready_to_ac.html http://www.michigan.gov/mdch/0,4612,7-132-2943_66797---,00.html

    http://www.msnbc.com/msnbc/ohio-medicaid-expansion http://www.nejm.org/doi/full/10.1056/NEJMsa1212321#t=articleBackground http://www.theoaklandpress.com/20130827/michigan-senate-approves-landmark-medicaid-expansion-for-the-working-poor

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    The Michigan Policy Network is a student-led public education and research program to report and organize news and information about the political process surrounding Michigan state policy issues. It is run out of the Department of Political Science at Michigan State University, with participation by students from the College of Social Science, the College of Communication, and James Madison College. 

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    Meet your Policy Fellow: Leah Brynaert

    Leah Brynaert is Health Care Fellow & Correspondent for the Michigan Policy Network. She is a first-year student in Lyman Briggs College at MSU.