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Medicaid Expansions Linked to Fewer Deaths

By Rebecca Adams, CQ HealthBeat Associate Editor

July 25, 2012 -- As state officials grapple with the question of whether to expand Medicaid in 2014 under the health care law, a Harvard School of Public Health report released Wednesday found that in three states that already extended the program, the death rates declined on average by more than 6 percent per year.

The study looked at mortality and other factors over a decade in Arizona, Maine, and New York, where Medicaid was expanded to childless adults. Mortality in those states fell by 6.1 percent compared with neighboring states that did not expand Medicaid. That means that for every 176 people who gained coverage, one death per year was prevented.

The rate of death fell the most among older adults, minorities and people living in poorer counties. The state with the biggest decline in mortality was New York.

“Sometimes the political rhetoric is at odds with the evidence, such as claims that Medicaid is a ‘broken program’ or worse than no insurance at all,” Arnold Epstein, chairman of the Department of Health Policy and Management, said in a written statement. “Our findings suggest precisely the opposite.”

Many states’ Medicaid programs only cover low-income children, parents, pregnant women and people with disabilities. However, some states have expanded Medicaid to cover adults who don’t have children.

All states would have been required to cover low-income childless adults by 2014 under the health care law (PL 111-148, PL 111-152) as enacted or risk losing all Medicaid funding for existing programs. But the Supreme Court’s June 28 ruling says that states must be allowed to choose whether to extend coverage to this population without jeopardizing federal matching funds for the rest of the program. Governors and state officials across the nation are currently weighing whether or not to expand.

The study, published in the online version of the New England Journal of Medicine, was conducted by Harvard professors Epstein, Benjamin Sommers (who is now an advisor in the Department of Health and Human Services Office of the Assistant Secretary for Planning Evaluation) and Katherine Baicker, a member of the Medicare Payment Advisory Commission (MedPAC). It will be in the Sept. 13 print edition.

The study’s authors suggested that officials should consider the health effects of expansion.

Medicaid expansions also were linked with lower rates of delaying medical treatment because of costs and increased rates of people reporting themselves to be in “excellent” or “very good” health.

“Policymakers should be aware that major changes in Medicaid—either expansions or reductions in coverage—may have significant effects on the health of vulnerable populations,” the study said.

Previous research has been mixed. Some observational studies have shown a correlation between Medicaid coverage and poor health outcomes for adults in the program. That has led to the claim that Medicaid coverage could be worse than no coverage at all. But the authors said that other factors affected the health of the population included in those studies in ways that “make Medicaid patients sicker than others.”

Other research in the 1980s showed lower mortality among children with Medicaid coverage compared to those who did not, according to the new study.

Arizona had expanded coverage to childless adults with incomes below the federal poverty level in 2001 and to parents with incomes up to 200 percent of the federal poverty level in 2002. Maine expanded eligibility to childless adults with incomes up to the federal poverty level in 2002. New York expanded eligibility to childless adults with incomes up to the federal poverty level and parents with incomes up to 150 percent of the federal poverty level in 2001.

Arizona’s population was compared to Nevada and New Mexico. Maine’s residents were compared to those in New Hampshire. New York Medicaid recipients were compared to similar populations without Medicaid coverage in Pennsylvania.

Rebecca Adams can be reached at [email protected].

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