A Medicaid Expansion for Michigan: The Facts Speak for Themselves

February 4, 2013

The Supreme Court’s June 2012 decision on the constitutionality of the Affordable Care Act made the Medicaid expansion—a cornerstone of the coverage expansion included in the law—an option rather than a requirement for states. To help Michigan policy makers make an informed decision on that expansion, we published a brief on the economic impact of the Medicaid expansion in Michigan. That brief noted under the most likely scenario, Michigan would save almost $1 billion over 10 years if it chose to expand Medicaid as contemplated in the ACA.

Since we published that brief in October 2012, policy makers have raised other questions related to the possible expansion. Most notably, Governor Snyder had concerns about whether or not providers in Michigan would have enough capacity to serve an expanded population. His concern was if Michigan lacked primary care capacity, newly eligible Medicaid recipients could end up seeking care in the emergency room, thus driving up costs for the state.

As it turns out, a survey of primary care physicians we had fielded in the fall of 2012 (from October through December) shed light on that very question. We now have, hot off the press, an answer to the Medicaid capacity question from our survey of primary care providers.

The survey results were enormously heartening on the readiness of primary care physicians to serve patients who should be getting coverage in 2014: 81 percent of primary care physicians overall in the state said they have enough capacity to expand their practices to take patients who will be newly covered by private coverage and Medicaid.

Of primary care physicians in the state, 55 percent said they take Medicaid patients today. Almost all of those said that they had capacity to serve new Medicaid patients in the future.

But what was particularly encouraging was this: of physicians who said they had capacity to accept new patients but don’t take Medicaid today, more than 80 percent in every practice category (family medicine, internal medicine, and pediatrics) said that they have the capacity to serve newly eligible Medicaid patients.

This is exciting news and should give policy makers confidence that as a state, we will be ready for a Medicaid expansion in 2014.

As I discussed these findings with reporters in the run up to the public release of our issue brief, I said I thought the state should indeed expand Medicaid. After I made that statement, a reporter asked me if we were changing our mission and becoming an advocacy organization. We are not. Our commitment is to provide non-partisan, factual information that is useful for policy makers. Our economic analysis and provider survey were powerful pieces of data. Those data, combined with what we know about the positive influence of health insurance on health and a recent American Cancer Society funded survey that showed that 63 percent of Michigan registered voters want the expansion, paint a compelling picture.

In this particular case it is hard not to conclude, based on the facts, that an expansion of the Medicaid program would be good for the state of Michigan.