Medicaid expansion in U.S. states found to cut death rates

Wed Jul 25, 2012 5:21pm EDT

A patient waits in the hallway for a room to open up in the emergency room at Ben Taub General Hospital in Houston, Texas, July 27, 2009. REUTERS/Jessica Rinaldi

A patient waits in the hallway for a room to open up in the emergency room at Ben Taub General Hospital in Houston, Texas, July 27, 2009.

Credit: Reuters/Jessica Rinaldi

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(Reuters) - State expansions of the Medicaid health insurance program for poor Americans reduced adult mortality rates by more than 6 percent compared to states that did not broaden eligibility for their plans, according to a study released on Wednesday.

The findings published in the New England Journal of Medicine could fuel a political furor over new plans for a nationwide expansion of Medicaid that erupted after the U.S. Supreme Court's ruling to uphold President Barack Obama's healthcare law in late June.

In an unexpected move, the high court ruling also left it up to states to decide whether to participate in the law's broader eligibility criteria for Medicaid that would extend insurance coverage to as many as 16 million more Americans starting in 2014. At least five Republican governors who opposed the healthcare law have vowed to opt out of the expansion, saying the program will pose a huge financial burden.

The lead author of the study was Benjamin Sommers, an assistant professor in health policy and economics at the Harvard School of Public Health who is temporarily working as an advisor to the U.S. Department of Health and Human Services. According to a disclosure note in the study, the paper was conceived and drafted while Sommers was employed at Harvard and the findings do not reflect official U.S. government policy.

The study examined three states that substantially broadened Medicaid eligibility for adults since 2000 -- New York, Maine and Arizona. They were compared to neighboring states that did not implement expansions -- Pennsylvania (for New York), New Hampshire (for Maine) and Nevada and New Mexico (for Arizona).

Adults between the ages of 20 and 64 years old were studied for five years before and after the expansion, using data from the U.S. Centers for Disease Control and Prevention.

Medicaid expansions were associated with a reduction in mortality from all causes, by 19.6 deaths per 100,000 adults, for a 6.1 percent decrease compared to the states without expansions.

The mortality declines were greatest among adults between ages 35 and 64, minorities and residents of poor counties.

The expansions also led to decreased rates of uninsurance, lower rates of delayed care because of costs, and an increase in the rate of people reporting their health status as "excellent" or "very good".

"The takeaway is that state expansions of Medicaid coverage to adults appear to be effective at improving both access to care and health for low-income Americans," Sommers said in an interview.

The results corresponded to 2,840 deaths prevented per year in the states with Medicaid expansions. That figure suggests that 176 additional adults would need to be covered by Medicaid in order to prevent one death per year, according to the study.

(Reporting by Lewis Krauskopf; Editing by Michele Gershberg and Carol Bishopric)

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Comments (4)
WillyC wrote:
The Good News & Bad News are the same: More ill people saved by government spending will live longer provided we spend more to keep them alive – and the longer they live, the more we spend.

When do we face the financial reality of all this?

Jul 26, 2012 11:32am EDT  --  Report as abuse
sure wrote:
Are the rates statewide of just for the Medicaid population? What did they control for? For example, did they commpare changes in Medicaid death rates with those of the overall or non-MedicAID population? Did Medicaid death rates drop because people with higher incomes and healthier lifestyles were added to Medicaid? Irv Leveson

Jul 26, 2012 12:13pm EDT  --  Report as abuse
Esteev wrote:
Let’s not forget, WillyC, that when you give medical care to these damned poor people, they don’t have to wait around without care until it becomes a VERY expensive emergency which the state usually ends up paying for.

During my ED clerkship, I saw MANY people forced to use the ED, because they never saw a doc for their hypertension and high cholesterol and are now in critical heart failure or having a heart attack or in liver failure or any number of other extremely expensive negative outcomes that result from not getting timely, adequate – and cheaper – care

Many studies have shown the same thing: spending money on early intervention SAVES money in the long run. Example: poor, uninsured mother never gets prenatal care. She doesn’t know B12 and folate are critical for the development of her baby. Maybe she doesn’t know that smoking or digging around in the cat box could end up giving her baby birth defects and cognitive impairment? The emotional and financial consequences of allowing this to happen far outweighs the cost of giving her at least some basic medical care

Jul 26, 2012 11:27pm EDT  --  Report as abuse
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