The “Shocking this even had to be Written” Chronicles: Study Finds Expanded Medicaid Saves Lives — and Could Have Saved More.
When the Affordable Care Act (the “ACA” or, informally, “Obamacare”), was passed in 2010, it called for expansion of Medicaid eligibility to provide health coverage for millions of additional low-income individuals. Generally, before the ACA, childless, low-income adults were not eligible for Medicaid coverage, resulting in a group of millions of adults under the poverty line who had no health coverage.
But uniform Medicaid expansion never occurred. In 2012, in National Federation of Independent Business v. Sebelius, 567 U.S. 519 (2012), the Supreme Court held that states could not be forced to expand eligibility for their Medicaid programs — so it was left up to each individual state to decide whether to expand. As of today, roughly 75% of the states have expanded (or are in the process of expanding) Medicaid coverage. The 14 nonexpansion states are listed here.
The two groups of expansion v. nonexpansion states made for a natural experiment to test what should be a staggeringly mundane hypothesis: “Providing access to health insurance increases positive health outcomes.”
Unfortunately, this “staggeringly mundane hypothesis” was not as “staggeringly mundane” as one would hope from the perspective of lawmakers. In 2017, while the then-GOP-controlled Congress was pushing to repeal the ACA, Rep. Raúl Labrador (R-Idaho), famously brushed off objections to Medicaid cuts, declaring, “ “Nobody dies because they don’t have access to health care.” Despite this sentiment, the ACA narrowly avoided repeal, and Medicaid expansion remained alive.
Fortunately, studies are now trickling in to answer the evidently difficult question of whether access to health coverage has any effect on health outcomes.
The results will SHOCK YOU…
… with how obvious they are.
In a recent paper published in the National Bureau of Economic Research, researchers analyzed the impact of Medicaid enrollment on mortality rates in expansion v. nonexpansion states.
In just the few intervening years since expansion, the observed mortality rates were about 0.2% lower in expansion states than in nonexpansion states. Translating this into individual mortality outcomes, the researchers estimated that, over just the first four years of expansion, the expansion states recorded 19,200 fewer deaths — while the nonexpansion states saw 15,600 additional deaths during the same period. According the paper:
“Prior to the expansions, individuals in our sample residing in expansion and non-expansion states had very similar trends in both Medicaid coverage and mortality. At the time of the expansion, the trajectories of these two groups diverged significantly, with expansion state residents seeing increases in Medicaid coverage and decreases in the probability of being uninsured, and decreases in annual mortality rates.”
Of course, since expansion has only just begun, one would expect future studies to reflect a widening disparity between the mortality rates in expansion v. nonexpansion states. Further, this study only examines mortality — meaning the litany of potential non-fatal health disparities are entirely ignored.
Staggeringly mundane conclusion: In America, if you’re poor, make sure you’re not poor in the wrong place.
