Article from Kaiser Health News Medicaid Expansion

KaiserHealth News – July 25, 2012

“Capsules”blog – Short Takes on News & Events

MedicaidExpansion Reduces Mortality, Study Finds

By Matthew Fleming

As states decide whether to expand theirMedicaid programs to cover low-income childless adults, the impact of theirchoices became clearer today in a study showing areduction of mortality in states that have already made that move.

The research published in the New EnglandJournal of Medicine found a 6.1 percent reduction in mortality among low-incomeadults between the ages of 20 and 64 in Maine, New York and Arizona — threestates that expanded coverage since 2000, compared with similar adults in NewHampshire, Pennsylvania, Nevada and New Mexico, neighboring states that did notdo so.

The decline in mortality, by an overall 19.6deaths per 100,000 adults, was especially pronounced among older individuals,minorities and residents of the poorest counties. The researchers analyzed dataspanning five-year periods before and after the three states extended theirMedicaid coverage to poor, childless adults.

The study also found “improved coverage,access to care and self-reported health” among the newly covered adults.

“It seems intuitive, but there’s beensurprisingly little evidence so far,” said lead researcher Benjamin D. Sommers,M.D., Ph.D., an assistant professor of health policy and economics at theHarvard School of Public Health. “There’s been some [research] on pregnantwomen and children, but much less on adults. And right now there are asignificant number of people arguing that Medicaid is worsethan nothing at all.”

The Supreme Court onJune 28 struckdown as unduly coercive a provision of the 2010 federal health care lawthat sought to force all states to extend Medicaid coverage to everyone withincomes up to 133 percent of the federal poverty level — currently $14,856 forindividuals and $25,390 for a family of three. Although the federal governmentwill pay the full cost of the expanded coverage for three years starting in2014, and at least 90 percent thereafter, a number of state governors have saidthey will not approve the wider coverage.

The study’s authors — Sommers, KatherineBaicker, Ph.D. and Arnold M. Epstein, M.D. — said their research results areconsistent with previous analyses finding an 8.5 percent reduction in infantmortality and a 5.1 percent drop in child mortality as a result of Medicaidexpansions in the 1980s.

The authors cautioned that their study“cannot definitively show causality,” because other factors might havecontributed to the reduction in death rates in the population newly covered byMedicaid. Among those factors, they said, was the possibility that “expandingcoverage had positive spillover effects through increased funding to providers,particularly safety-net hospitals and clinics.” But they said they were notaware of any large-scale changes in health policy in the three states theystudied.
“This answers the question of what happenswhen you give people Medicaid who didn’t already have coverage, as opposed tocomparing people who have Medicaid with people who have something else,” saidSommers. “The latter is not apples to apples, because Medicaid recipients areusually sicker and with worse socioeconomic conditions.”