Medicaid Expansion Reduces Mortality, Study Finds

Benjamin D. Sommers, M.D., Ph.D., Katherine Baicker, Ph.D., and Arnold M. Epstein, M.D published “Mortality and Access to Care among Adults after State Medicaid Expansions” in the New England Journal of Medicine.

Find the study here – http://www.nejm.org/doi/full/10.1056/NEJMsa1202099. 

Here is the brief, taken from the website above –

BACKGROUND: Several states have expanded Medicaid eligibility for adults in the past decade, and the Affordable Care Act allows states to expand Medicaid dramatically in 2014. Yet the effect of such changes on adults' health remains unclear. We examined whether Medicaid expansions were associated with changes in mortality and other health-related measures.

RESULTS: Medicaid expansions were associated with a significant reduction in adjusted all-cause mortality (by 19.6 deaths per 100,000 adults, for a relative reduction of 6.1%; P=0.001). Mortality reductions were greatest among older adults, nonwhites, and residents of poorer counties. Expansions increased Medicaid coverage (by 2.2 percentage points, for a relative increase of 24.7%; P=0.01), decreased rates of uninsurance (by 3.2 percentage points, for a relative reduction of 14.7%; P<0.001), decreased rates of delayed care because of costs (by 2.9 percentage points, for a relative reduction of 21.3%; P=0.002), and increased rates of self-reported health status of “excellent” or “very good” (by 2.2 percentage points, for a relative increase of 3.4%; P=0.04).

CONCLUSIONS: State Medicaid expansions to cover low-income adults were significantly associated with reduced mortality as well as improved coverage, access to care, and self-reported health.

The full text and discussion is available.

The release received significant coverage –

Kaiser Health News reported that “As states decide whether to expand their Medicaid programs to cover low-income childless adults, the impact of their choices became clearer today in a study showing a reduction of mortality in states that have already made that move.”

Find this article, by Matthew Fleming (JULY 25TH, 2012, 5:00 PM) here: http://capsules.kaiserhealthnews.org/index.php/2012/07/medicaid-expansion-reduces-mortality-study-finds/.

As reported by KHN, “The research published in the New England Journal of Medicine found a 6.1 percent reduction in mortality among low-income adults between the ages of 20 and 64 in Maine, New York and Arizona — three states that expanded coverage since 2000, compared with similar adults in New Hampshire, Pennsylvania, Nevada and New Mexico, neighboring states that did not do so.”

KHN also reports that 1) “The decline in mortality, by an overall 19.6 deaths per 100,000 adults, was especially pronounced among older individuals, minorities and residents of the poorest counties,” and 2) “The study also found “improved coverage, access to care and self-reported health” among the newly covered adults.”

The study comes after “the Supreme Court struck down a provision of the 2010 federal health care law that sought to force all states to extend Medicaid coverage to everyone with incomes up to 133 percent of the federal poverty level. That level, according to KHN is currently $14,856 for individuals and $25,390 for a family of three.

As we have covered previously, KHN reminds us that “Although the federal government will pay the full cost of the expanded coverage for three years starting in 2014, and at least 90 percent thereafter, a number of state governors have said they will not approve the wider coverage.”

The authors cautioned that their study “cannot definitively show causality,” because other factors might have contributed to the reduction in death rates in the population newly covered by Medicaid. Among those factors, they said, was the possibility that “expanding coverage had positive spillover effects through increased funding to providers, particularly safety-net hospitals and clinics

From KHN’s report: “This answers the question of what happens when you give people Medicaid who didn’t already have coverage, as opposed to comparing people who have Medicaid with people who have something else,” said Sommers. “The latter is not apples to apples, because Medicaid recipients are usually sicker and with worse socioeconomic conditions.”

Kaiser Health News also reports other sources covering the story –

Los Angeles Times: Medicaid May Help People Live Longer, Study Indicates

As states consider whether to expand their Medicaid insurance programs for the poor under President Obama’s healthcare law, new research indicates the decision may have life-and-death consequences. A study published Wednesday in the New England Journal of Medicine indicates that residents of states that expand coverage will probably live longer, be healthier and have better access to medical care (Levey, 7/25).

The New York Times: Medicaid Expansion May Lower Death Rates, Study Says

Into the maelstrom of debate over whether Medicaid should cover more people comes a new study by Harvard researchers who found that when states expanded their Medicaid programs and gave more poor people health insurance, fewer people died (Belluck, 7/25).

The Wall Street Journal: Death Rates Vary In Medicaid Study

States that opted for larger Medicaid programs had lower death rates, according to a study released Wednesday in the New England Journal of Medicine. The findings come as states struggle with the growing financial burden of the health-insurance program for the poor, and weigh whether to take part in its expansion under President Barack Obama's health-care law (Dooren, 7/25).

The Associated Press/Wall Street Journal: Study: New Medicaid Expansion Could Be A Lifesaver

Until now, the Medicaid debate has been about budgets and states' rights. But a statistical study by Harvard researchers in the New England Journal of Medicine found a 6 percent drop in the adult death rate in Arizona, Maine and New York, three states that have recently expanded coverage for low-income residents along the general lines of the federal health care law. The study found that for every 176 adults covered under expanded Medicaid, one death per year would be prevented (7/25).