I’ve lost count of how many times I’ve heard people say “Medicaid expansion will encourage people not to work,” despite the fact that multiple studies have demonstrated just the opposite. We know that before the pandemic, most adults enrolled in Medicaid who could work did so, and the majority of adults who weren’t working reported barriers to seeking or maintaining employment, including caregiving conflicts, illness, disability, and transportation issues. Furthermore, in surveys from Ohio and Michigan, a majority of Medicaid enrollees stated that Medicaid expansion coverage has improved their job performance and their ability to seek employment.
Adding to this body of evidence, the evaluators of the Health Michigan Plan published this study in JAMA, and it’s likely the first study to provide longitudinal data on the relationship between Medicaid and work and student status. In their research, the evaluators found that people who were enrolled in the program in 2016 were significantly more likely to be employed or in school the following year as compared to the previous year (54.3% in 2016 and 60.0% in 2017).
In addition to this noteworthy finding, further demographic analysis shows that Black respondents and respondents with incomes below 35% of the poverty level saw the largest gains in employment and/or student status. There were also significant employment and student status gains for enrollees with chronic health conditions and mental health or substance use disorders. While this study does not establish causality, we know from previous research that access to coverage and care is positively associated with employment, and that lack of access to mental health and substance use disorder treatment is a strong predictor of unemployment, a factor that could very well be at play in the employment gains among Michigan Medicaid enrollees who reported having these conditions.
Additionally, the geographic analysis reveals that enrollees living in Central, Southern, and metropolitan Detroit reported larger increases in employment than those living in Northern Michigan, the most rural region of the state, though none of the regional changes were statistically significant. Rural unemployment tends to be higher and public transportation infrastructure is often less developed in rural areas, two factors that could impede job-seeking efforts in more rural areas.
The data for this study were collected before Michigan implemented work reporting requirements (though there were never coverage losses associated with this policy because a federal court invalidated the waiver before the state-initiated disenrollments), and the findings provide more evidence that Medicaid coverage supports work. This stands in stark contrast to the research on work reporting requirements that, when implemented in Arkansas, led to coverage losses and was not associated with any increase in employment status among people with Medicaid coverage. Moreover, later research found that people who lost coverage had increased medical debt and delays in care due to cost concerns.
While talking points about Medicaid expansion disincentivizing work (which are rooted in racist, classist, and sexist stereotypes) are sure to persist in the political discourse, the research does not support this claim—in fact, the evidence directly contradicts it.