Better health benefits linked to better job numbers

View Transcript

The recent study shows the biggest job gains were seen among low income adults with serious health problems whose health improved over time. Read the full article on Health Lab.

Transcript 

Host: 

Welcome to Health Lab, your destination for news and stories about the future of healthcare. 

Today, as Medicaid work requirements loom, a new study finds links between health insurance coverage, better health and higher employment, showing the biggest job gains happening among low income adults with serious health problems whose health improved over time.

Recent federal legislation requires that the 40 states that expanded Medicaid under the Affordable Care Act start implementing work requirements in their Medicaid programs by January 2027.

But a new University of Michigan study suggests that those requirements may work against their intended purpose.

The new work requirements mean that people with low incomes will need to prove they’re working, or have a specific reason not to work, in order to keep their Medicaid health coverage.

If they don’t meet deadlines or submit the right information, they could lose their health care coverage.

But the new study shows that Medicaid coverage itself is associated with employment gains, especially among those least likely to have jobs: people with both low incomes and burdensome health problems.

The study also shows that health improvements among Medicaid enrollees are strongly associated with employment gains.

Employment nearly doubled among Medicaid enrollees who started out with substantial health problems but saw their health improve.

By the end of the study period, 47% held full- or part-time jobs, which was up from the 26% where it started.

Among those with moderate or substantial health burdens, 38% of enrollees who were unemployed in 2016, but later reported improved health, had jobs by 2018; and that’s compared with just 14% of those whose health remained unchanged or worsened in that time.

The study also shows employment gains among Medicaid enrollees with medium and low levels of total health burdens. However, most people in these groups started out employed or self-employed, either full- or part-time.

The findings, published in JAMA Health Forum, come from a team at the U-M Institute for Healthcare Policy and Innovation that has evaluated Michigan’s Medicaid expansion for over a decade.

Lead author of the study, Minal Patel, Ph.D. says, “These findings show that Medicaid expansion doesn't discourage work—it helps make it possible. By improving health, Medicaid allows people to participate more fully in the workforce."

The mandate for work requirements in states that have expanded Medicaid under the Affordable Care Act was signed into law this summer as part of the One Big Beautiful Bill Act.

The Congressional Budget Office has estimated that nearly 5 million Americans may lose Medicaid coverage, even if they still qualify for it, between 2027 and 2034.

IHPI’s evaluation of Michigan’s Medicaid expansion, which is called the Healthy Michigan Plan, was required by the Centers for Medicaid and Medicare Services and conducted under a contract from the Michigan Department of Health and Human Services.

Patel worked with senior author and U-M Medical School professor Dr. Susan Goold, and the rest of the IHPI evaluation team to analyze survey data and records from more than 4,000 Healthy Michigan Program enrollees.

HMP currently covers 716,000 Michiganders with incomes up to 133% of the poverty level.

During the study period, that was an annual income of about $16,500 for an individual, which is equivalent to earning about $8 an hour and working 40 hours a week.

All the study participants had coverage under the Healthy Michigan Plan when they participated in a survey in 2016 that included questions about their health and employment.

Most were surveyed again in 2017 and 2018, though some had left Medicaid by that time.

The study was done before a Michigan-specific work requirement briefly took effect in 2020 and was ended by a federal court decision, before any individuals lost coverage.

So what does the study show about the relationship between health status and employment status?

At the outset of the study, 18% of enrollees had a substantial health burden. Health burden is a measure the IHPI team developed to integrate multiple measures of health status, including the number of days in the past month when someone said their physical or mental health wasn’t good or kept them from engaging in usual activities.

Another 13% had a moderate health burden, and 69% had a minimal health burden.

In the full cohort of Healthy Michigan Plan enrollees, 57% had at least one chronic condition, including diabetes, heart disease, stroke, arthritis, COPD, asthma, high blood pressure or cancer.

Half of the enrollees with substantial or moderate health burden who took follow-up surveys said their health had improved over time.

Most of those with minimal health burden said their health stayed about the same.

At the start in 2016, 48% of the surveyed enrollees were employed or self-employed.

But enrollees with substantial health burdens had much lower levels of employment at the start of the study, and had the biggest jumps in employment over time - from 26% to 47% - and those who said their health improved had the biggest employment gains.

Among enrollees who started with moderate health burden and saw improved health, 48% were employed at the start but 67% had jobs by the end.

Those with minimal health burden whose health stayed the same also saw employment rise, increasing from 59% to 71%.

A reminder that all Health Lab content including health news, best practices and research insights are for informational purposes only, and are not a substitute for professional medical guidance. Always seek the advice of a health care provider for questions about your health and treatment options.

For more on this story and for others like it, visit michiganmedicine.org/health-lab where you can also subscribe to our Health Lab newsletters to receive the latest in health, wellness and medical research information to your inbox each week. Health Lab is a part of the Michigan Medicine Podcast Network, and is produced by the Michigan Medicine Department of Communication. You can subscribe to Health Lab wherever you listen to podcasts.