Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor.
Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.
JAMA Netw Open. 2020 Jul 1;3(7):e208776. doi: 10.1001/jamanetworkopen.2020.8776.
Evidence about the health benefits of Medicaid expansion has been mixed and has largely come from comparing expansion and nonexpansion states.
To examine the self-reported health of enrollees in Michigan's Medicaid expansion, the Healthy Michigan Plan (HMP), over time.
DESIGN, SETTING, AND PARTICIPANTS: A telephone survey from January 1 to October 31, 2016 (response rate, 53.7%), and a follow-up survey from March 1, 2017, to January 31, 2018 (response rate, 83.4%), were conducted in Michigan, which expanded Medicaid in 2014 through a Section 1115 waiver permitting state-specific modifications. Four thousand ninety HMP beneficiaries aged 19 to 64 years with at least 12 months of HMP coverage and at least 9 months in a Medicaid health plan were eligible to participate. Data were analyzed from April 1 to November 30, 2018.
Surveys measured demographic characteristics and health status. Analyses included weights for sampling probability and nonresponse. Comparisons between 2016 and 2017 included those who responded to both surveys (n = 3097).
Of the 3097 respondents to the 2017 follow-up survey, 2388 (77.1%) were still enrolled in HMP (current enrollees) and 709 (22.9%) were no longer enrolled when surveyed (former enrollees). Among all follow-up respondents, a weighted 37.5% (95% CI, 35.3%-39.9%) were aged 19 to 34 years, 34.0% (95% CI, 31.8%-36.2%) were aged 35 to 50 years, and 28.5% (95% CI, 26.7%-30.3%) were aged 51 to 64 years; 53.0% (95% CI, 50.8%-55.3%) were female. Respondents who reported fair or poor health decreased from 30.7% (95% CI, 28.7%-32.8%) in 2016 to 27.0% (95% CI, 25.1%-29.0%) in 2017 (adjusted odds ratio [AOR], 0.66 [95% CI, 0.53-0.81]; P < .001), with the largest decreases observed in respondents who were non-Hispanic black (from 31.5% [95% CI, 27.1%-35.9%] in 2016 to 26.0% [95% CI, 21.9%-30.1%] in 2017; P = .009), from the Detroit metropolitan area (from 30.7% [95% CI, 27.0%-34.4%] in 2016 to 24.9% [95% CI, 21.6%-28.3%] in 2017; P = .001), and with an income of 0% to 35% of the federal poverty level (from 37.6% [95% CI, 34.2%-40.9%] in 2016 to 32.3% [95% CI, 29.1%-35.5%] in 2017; P < .001). From 2016 to 2017, the mean number of days of poor physical health in the past month decreased significantly from 6.9 (95% CI, 6.5-7.4) to 5.7 (95% CI, 5.3-6.0) (coefficient, -6.10; P < .001), including among current (from 7.0 [95% CI, 6.5-7.5] to 5.6 [95% CI, 5.1-6.0]; P < .001) and former (from 6.8 [95% CI, 5.9-7.7] to 5.8 [95% CI, 5.0-6.7]; P = .02) enrollees, those with 2 or more chronic conditions (from 9.9 [95% CI, 9.3-10.6] to 8.5 [95% CI, 7.8-9.1]; P < .001), across all age groups (19-34 years, from 4.3 [95% CI, 3.7-4.9] to 3.0 [95% CI, 2.5-3.5]; P < .001; 35-50 years, from 8.2 [95% CI, 7.3-9.0] to 6.9 [95% CI, 6.1-7.7]; P = .002; 51-64 years, from 9.0 [95% CI, 8.2-9.8] to 7.6 [95% CI, 6.9-8.3]; P = .001), and among non-Hispanic white (from 7.5 [95% CI, 7.0-8.1] to 6.1 [95% CI, 5.6-6.6]; P < .001) and black (from 5.9 [95% CI, 5.1-6.8] to 4.4 [95% CI, 3.6-5.1]; P < .001) respondents. No changes in days of poor mental health or usual activities missed owing to poor physical or mental health were observed.
These findings suggest that HMP enrollees in Michigan have experienced improvements in self-reported health over time, including minority groups with a history of health disparities and enrollees with chronic health conditions.
关于医疗补助扩大的健康益处的证据喜忧参半，主要来自对扩大和不扩大的州的比较。
随着时间的推移，检查密歇根州医疗补助扩大计划（Healthy Michigan Plan，HMP）中参保者的自我报告健康状况。
设计、地点和参与者：2016 年 1 月 1 日至 10 月 31 日进行了电话调查（响应率为 53.7%），2017 年 3 月 1 日至 2018 年 1 月 31 日进行了后续调查（响应率为 83.4%）。密歇根州在 2014 年通过了第 1115 项豁免，允许对特定州进行修改，从而扩大了医疗补助。符合条件的有 4097 名年龄在 19 至 64 岁之间的 HMP 受益人和至少 12 个月的 HMP 覆盖范围和至少 9 个月的医疗补助健康计划。数据分析于 2018 年 4 月 1 日至 11 月 30 日进行。
调查衡量了人口统计学特征和健康状况。分析包括抽样概率和无响应的权重。2016 年和 2017 年的比较包括那些同时对两项调查做出回应的人（n=3097）。
在 2017 年的后续调查中，3097 名应答者中有 2388 名（77.1%）仍在 HMP 参保（当前参保者），709 名（22.9%）在调查时已不再参保（前参保者）。在所有随访应答者中，加权后的 37.5%（95%置信区间，35.3%-39.9%）为 19 至 34 岁，34.0%（95%置信区间，31.8%-36.2%）为 35 至 50 岁，28.5%（95%置信区间，26.7%-30.3%）为 51 至 64 岁；53.0%（95%置信区间，50.8%-55.3%）为女性。报告健康状况不佳的受访者比例从 2016 年的 30.7%（95%置信区间，28.7%-32.8%）下降到 2017 年的 27.0%（95%置信区间，25.1%-29.0%）（调整后的优势比[OR]，0.66 [95%置信区间，0.53-0.81]；P<0.001），降幅最大的是非西班牙裔黑人受访者（从 2016 年的 31.5%（95%置信区间，27.1%-35.9%）降至 2017 年的 26.0%（95%置信区间，21.9%-30.1%）；P=0.009），来自底特律大都市区（从 2016 年的 30.7%（95%置信区间，27.0%-34.4%）降至 2017 年的 24.9%（95%置信区间，21.6%-28.3%）；P=0.001），以及收入为联邦贫困线的 0%至 35%（从 2016 年的 37.6%（95%置信区间，34.2%-40.9%）降至 2017 年的 32.3%（95%置信区间，29.1%-35.5%）；P<0.001）。从 2016 年到 2017 年，过去一个月内身体欠佳的天数明显减少，从 6.9（95%置信区间，6.5-7.4）降至 5.7（95%置信区间，5.3-6.0）（系数，-6.10；P<0.001），包括当前参保者（从 7.0（95%置信区间，6.5-7.5）降至 5.6（95%置信区间，5.1-6.0）；P<0.001）和前参保者（从 6.8（95%置信区间，5.9-7.7）降至 5.8（95%置信区间，5.0-6.7）；P=0.02），以及有 2 种或以上慢性疾病的参保者（从 9.9（95%置信区间，9.3-10.6）降至 8.5（95%置信区间，7.8-9.1）；P<0.001），涵盖所有年龄组（19-34 岁，从 4.3（95%置信区间，3.7-4.9）降至 3.0（95%置信区间，2.5-3.5）；P<0.001；35-50 岁，从 8.2（95%置信区间，7.3-9.0）降至 6.9（95%置信区间，6.1-7.7）；P=0.002；51-64 岁，从 9.0（95%置信区间，8.2-9.8）降至 7.6（95%置信区间，6.9-8.3）；P=0.001），以及非西班牙裔白人（从 7.5（95%置信区间，7.0-8.1）降至 6.1（95%置信区间，5.6-6.6）；P<0.001）和黑人（从 5.9（95%置信区间，5.1-6.8）降至 4.4（95%置信区间，3.6-5.1）；P<0.001）的受访者。未观察到心理健康或因身体或心理健康欠佳而错过的日常活动天数的变化。
这些发现表明，密歇根州 HMP 的参保者随着时间的推移，自我报告的健康状况有所改善，包括历史上存在健康差距的少数群体和患有慢性健康状况的参保者。
