About

Helen Levy is a research professor at the Institute for Social Research and the School of Public Health, with a courtesy appointment at the Ford School of Public Policy at the University of Michigan. Her research interests include the causes and consequences of lacking health insurance, evaluation of public health insurance programs, and material hardship among older Americans. She is a co-investigator on the Health and Retirement Study, a long-running longitudinal study of health and economic dynamics at older ages. Levy is a research associate at the National Bureau of Economic Research and served as a senior economist to the President's Council of Economic Advisers in 2010–11. She received a PhD in economics from Princeton University. Her work has been featured in media outlets such as The Washington Post, NPR Marketplace, and others, highlighting her expertise in health economics, social policy, and economic impacts of health insurance and aging.

Research topics

• Political Science
• Medicine
• Environmental health
• Pathology
• Nursing
• Actuarial science
• Economic growth
• Family medicine
• Business
• Law
• Demography
• Virology
• Economics

Selected publications

• The Price of Advice—Do Management Consultants Deliver Value to Nonprofit Hospitals?

  JAMA · 2026-05-04

  articleSenior author
  PublisherDOI

• Financial Outcomes Among Medicaid Expansion Enrollees

  JAMA Network Open · 2026-04-27

  articleOpen access

  Importance: Enrollment in Medicaid expansion may improve financial outcomes for low-income adults, but this association has not been studied in the longer-term postenrollment period. Objective: To estimate the association of enrollment in Medicaid expansion with financial outcomes for enrollees as long as 7 years after enrollment. Design, Setting, and Participants: This longitudinal cohort study used an event study analysis to compare changes in credit outcomes after relative to before enrollment, controlling for changes in outcomes over time, differences between individuals who enroll at different times, and linear trends in outcomes prior to enrollment. Participants included first-time enrollees in the Healthy Michigan Plan (HMP), Michigan's Medicaid expansion plan, between April 1, 2014, and December 31, 2017. Enrollees were linked with their credit reports from a large national credit agency at 6-month intervals from 2013 to 2021, with outcomes obtained on the final business day of January and July of each calendar year. Data were analyzed from January 4, 2023, to December 9, 2025. Exposure: Enrollment in HMP. Main Outcomes and Measures: The event study analysis compared changes in 4 credit outcomes: medical debt in collections, nonmedical debt in collections, a subprime credit score (<600), and bankruptcy in the prior 2 years. Results: The study cohort included 575 283 enrollees (308 814 male [53.7%]; mean [SE] age, 42.1 [10.6] years). HMP enrollment was associated with large reductions in medical debt in collections (from -$101.9 [95% CI, -$127.6 to -$76.3] in postenrollment quarter 8 to -$983.0 [95% CI, -$1090.8 to -$875.1] in postenrollment quarter 29) and rates of subprime credit scores (from -0.038 [95% CI, -0.041 to -0.035] in postenrollment quarter 8 to -0.234 [95% CI, -0.247 to -0.221] in postenrollment quarter 29), with the magnitude of association increasing over time. No associations were observed between HMP enrollment and nonmedical debt in collections or bankruptcy. Conclusions and Relevance: In this cohort study of HMP enrollees, Medicaid expansion enrollment was associated with reductions in medical debt in collections and rates of subprime credit scores as long as 7 years after enrollment. These results suggest enrollment in Medicaid expansion was associated with excellent protection from out-of-pocket costs of medical care and overall improved financial stability, which in turn may be associated with improvements in enrollees' health and well-being.

  PublisherDOI

• Health Insurance Data in the PSID

  SSRN Electronic Journal · 2026-01-01

  preprintOpen access1st authorCorresponding
  PublisherDOI

• Health Care Utilization and Costs for Older Adults Aging Into Medicare After the Affordable Care Act

  JAMA Health Forum · 2025-01-17 · 3 citations

  articleOpen access

  Importance: The Affordable Care Act (ACA) expanded Medicaid and Marketplace insurance to nonelderly adults in 2014, but whether these policies improved outcomes later in life is unknown. Objective: To examine whether exposure to ACA expansions during middle age (50-64 years) was associated with changes in health, utilization, and spending after these adults entered Medicare at 65 years of age. Design, Setting, and Participants: This serial analysis of the Health and Retirement Study cohort linked to Medicare enrollment and claims data from January 1, 2010, to December 31, 2018. Adults aged 65 to 68 years entering Medicare after the ACA (exposed to ACA expansions during middle age) were compared with adults entering Medicare before the ACA (4452 person-years). Interrupted time series analyses were used to assess overall changes associated with exposure to ACA expansions and difference-in-differences analyses to isolate changes associated with Medicaid expansion among low-income adults (incomes ≤400% of the federal poverty level for any ACA coverage and ≤138% for Medicaid expansion coverage). Data were analyzed from March 1, 2023, to May 1, 2024. Exposures: ACA coverage expansion overall in 2014 and Medicaid expansion as of 2018. Main Outcomes and Measures: Health (self-reported overall, activities of daily living [ADL], instrumental ADL, and depressive symptoms), utilization (outpatient visits, emergency department visits, and hospital admission), and costs (self-reported out-of-pocket and Medicare costs). Results: Among the analytic sample of 2782 participants (mean age, 66.4 [95% CI, 66.3-66.5] years), a weighted 59.1% (95% CI, 55.3%-62.7%) were female. In interrupted time series analyses, reductions across cohorts were found in use of chronic disease medications (-5.0 [95% CI, -9.8 to -0.3] percentage points), hospitalizations per year (-0.2 [95% CI, -0.4 to -0.03]), and out-of-pocket costs (-$417 [95% CI, -$694 to -$139]) but no significant changes across cohorts in health status, outpatient or emergency visits, or Medicare costs. In difference-in-differences analyses relative to nonexpansion states, greater reductions were found in the number of ADL limitations (-0.4 [95% CI, -0.8 to -0.02]) and lesser reductions in out-of-pocket costs ($900 [95% CI, $275-$1526]) in Medicaid expansion states but otherwise similar changes in other outcomes. Conclusions and Relevance: This study found modest evidence of reductions in out-of-pocket costs and improvements in health among adults entering Medicare after the ACA. Insurance coverage and financial assistance should be preserved and enhanced to improve health and health care access among vulnerable older adults.

  PublisherOA PDFDOI

• Older adults living with dementia enrolled in similar Medicare Advantage plans compared to those without dementia

  Alzheimer s & Dementia Behavior & Socioeconomics of Aging · 2025-05-05

  articleOpen accessSenior author

  Abstract INTRODUCTION Medicare Advantage (MA) plan selection may differ between older adults with or without dementia in unexplored ways. This study aims to characterize MA plan choice among those with dementia. METHODS We used the 2010 to 2018 waves of the Health and Retirement Study with linked Medicare enrollment data to identify MA respondents ≥ 65 years, with and without dementia. Conditional logit models examined how characteristics of MA plans affected choice. RESULTS Among respondents overall, there were no differences between those with versus without dementia regarding how plan out‐of‐pocket cost, star rating, and type affected choice. Among the dual eligible group, those with versus without dementia were more likely to choose Special Needs Plans (difference in log odds: 0.804, p = 0.007). DISCUSSION There were few differences in how MA plan characteristics affected choice among older adults with and without dementia. Older adults with dementia may make similar MA plan choices as those without.

  PublisherOA PDFDOI

• Association of Medicaid expansion with children's insurance coverage and healthcare utilization

  Health Affairs Scholar · 2025-12-19

  articleOpen access

  Introduction: In 2014, multiple states expanded Medicaid coverage to low-income adults under the Affordable Care Act. We evaluated the association of Medicaid expansion (ME) with children's insurance coverage and health service utilization. Methods: We compared changes in children's insurance coverage and health service utilization between 2010-2013 and 2014-2016 in expansion and non-expansion states. Repeated cross-sectional analysis with linear difference-in-differences (DID) models was conducted using the Medical Expenditure Panel Survey. Results: Medicaid expansion was not associated with changes in the proportion of children with ≥1 month of insurance coverage (DID: -1.9% point [pp], 95% CI -4.1 to 0.3) or the proportion of children with continuous coverage for 12 months (DID: -1.8 pp, 95% CI -5.6 to 2.0). Expansion was not associated with changes in any utilization outcome, including having ≥1 annual well-child visit (DID: -1.9 pp, 95% CI -6.6 to 2.8) or ≥1 annual dental visit (DID: 1.9 pp, 95% CI -2.8 to 6.5). Conclusion: Medicaid expansion was not associated with changes in children's coverage and utilization. While policymakers in states that have not yet expanded Medicaid might still consider doing so for other reasons, findings suggest that alternative interventions will be needed to improve coverage and utilization patterns in children.

  PublisherOA PDFDOI

• The Impact of Health Insurance on Mortality

  Annual Review of Public Health · 2025-01-10 · 14 citations

  reviewOpen access1st authorCorresponding

  considered the question of whether health insurance improves health. The answer was a cautious yes because few studies provided convincing causal evidence. We revisit this question by focusing on a single outcome: mortality. Because of multiple high-quality studies published since 2008, which exploit new sources of quasi-experimental variation as well as new empirical approaches to evaluating older data, our answer is more definitive. Studies using different data sources and research designs provide credible evidence that health insurance coverage reduces mortality. The effects, which tend to be strongest for adults in middle age or older and for children, are generally evident shortly after coverage gains and grow over time. The evidence now unequivocally supports the conclusion that health insurance improves health.

  PublisherDOI

• Partner Plan Choices and Medicare Advantage Enrollment Decisions Among Older Adults

  JAMA · 2024-03-20 · 2 citations

  articleOpen access

  This study examines the association of partner Medicare Advantage plan status over 1 year with beneficiary and plan characteristics.

  PublisherOA PDFDOI

• Baselining the Impact of the COVID-19 Pandemic: Social, Behavioral, and Economic Data Resources for High Quality Insights

  Deep Blue (University of Michigan) · 2024-08-06

  articleOpen access

  http://deepblue.lib.umich.edu/bitstream/2027.42/194193/1/Baselining the Impact of the COVID-19 Pandemic.pdf

  PublisherDOI

• HEALTH CARE USE AMONG SPOUSE CAREGIVERS OF OLDER ADULTS LIVING WITH DEMENTIA

  Innovation in Aging · 2024-12-01

  articleOpen access

  Abstract Little is known about how caregiving is associated with caregivers’ health care use, particularly where the care recipient is a person living with dementia [PLWD]. This study aims to characterize health care use of spouses of PLWD. Using the 2000–2018 Health and Retirement Study linked with Medicare claims data, we identified community-dwelling dyads where one member had dementia, both members were aged ≥65 years, and enrolled in fee-for-service Medicare; for dyads included in multiple waves, we randomly selected one wave (N=924 unique dyads). We examined the association of spouse care intensity with spousal health care use, adjusted for spousal socio-demographic, health, and functional characteristics. Forty-three percent of spouses did not provide care; and among those providing care, the average monthly hours were 27, 150, and 430 for the first, second, and third tertiles, respectively. Adjusted for spousal characteristics, spouses not providing help had higher total annual Medicare costs ($5,728 and $5,776 higher than those in the second and third tertiles, respectively, p&amp;lt;.05 for both), acute hospitalization (8.2% and 10.4% higher than those in the second and third tertiles, respectively, p&amp;lt;.05 for both), and sub-acute care (7.2% higher than those in the second tertile, p&amp;lt;.01). The spouses who did not provide caregiving hours had the highest health care costs and use. It is unclear whether PLWD spouses do not need care or whether these spouses, by virtue of their own health problems, do not have the capacity to provide caregiving.

  PublisherDOI

Recent grants

• NIH Grant K01AG034232

  NIH · $541k · 2016

Frequent coauthors

• Thomas C. Buchmueller

  University of Michigan–Ann Arbor

  69 shared

• David R. Weir

  University of Michigan–Ann Arbor

  31 shared

• Angela Fagerlin

  27 shared

• Sayeh Nikpay

  University of Minnesota

  24 shared

• Thomas DeLeire

  Georgetown University

  22 shared

• Jeffrey T. Kullgren

  22 shared

• Amanda J. Dillard

  Grand Valley State University

  16 shared

• Peter A. Ubel

  Duke University

  16 shared

Awards & honors

• Fellow, National Academy of Social Insurance