Getting covered by health insurance may have a major impact on a low income person’s ability to get a job or enroll in school, according to a new study that gives the first direct look at the relationship between the two.

The percentage of low income people enrolled in Michigan’s Medicaid expansion program who had jobs or were enrolled in school jumped six points in one year, the study shows. That outpaced employment gains among the state’s general population during that same time.

Even larger increases in employment and school enrollment happened among African Americans, men, people in their late 30s and 40s, and those with the lowest incomes.

The study of low income people enrolled in what the state calls the Healthy Michigan Plan was performed by a team at the University of Michigan Institute for Healthcare Policy and Innovation, and published in a new paper in JAMA Network Open.

Year-over-year gains

For the study, the researchers surveyed more than 3,000 people with Healthy Michigan Plan coverage from across the state, first in 2016 and again in 2017 or the first month of 2018. The program is open to all people over age 18 in Michigan who have incomes up to 133% of the poverty level, or about $15,800 for an individual and $32,000 for a family of four in 2017. About 670,000 Michiganders currently have the coverage.

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The six point jump in those who said they had a job or were in school was seen both in those who stayed in the program for the entire period studied, and among the 23% who had left the program by the time the researchers contacted them.

The findings have implications for states that haven’t expanded Medicaid under the Affordable Care Act, and for those that have applied for or received permission from the federal government to require enrollees to report whether they’re working, or doing other qualifying activities, in order to keep Medicaid coverage.

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“While on a statewide level, both in the general population and the low-income population, employment levels didn’t change much between 2016 and 2017, we saw a clear increase in employment or student status among those in the Healthy Michigan Plan, even among those with health conditions who we might think would need more time to achieve this,” says Renuka Tipirneni, M.D., M.Sc., the lead author of the new study and an assistant professor of internal medicine at U-M. “The ability to get access to care, attention for existing or new health issues, and to gain function, appears to have a clear impact on the chances of getting a job or studying or training to get a job later.”

Tipirneni is a member of the IHPI team that is carrying out a full evaluation of the Healthy Michigan Plan’s effects for the state government. She notes that the study is unique because it includes longitudinal data on the Medicaid expansion enrollee population, including those who have left the program. The team continues to gather data on the longer term status of these enrollees and former enrollees.