Thursday, July 26, 2012

States Medicaid Expansion Saves Lives

Some experts have said that individual States and the decisions they make around health care reform will have more impact on people than the Federal Government and the Accountable Care Act (Obamacare).  Since States will be able to "opt out" of of the reform law's Medicaid expansion, where a person resides may have a huge impact on their health.

A new study published in the New England Journal of Medicine by researchers at the Harvard School of Public Health compared death rates in three states that expanded Medicaid in the past decade - Arizona, Maine and New York, with four neighboring states that did not - New Hampshire, New Mexico, Nevada and Pennsylvania.   They looked at data from adults age 20-64 for five years before and five years after the expansions.  They found that expanding Medicaid eligibility lowered mortality rates by 6.1% compared to States that did not expand.  They also found that death rates declined the most in minorities and residents in lower-income counties.  Additionally there was an increase in individuals who reported their health status as "excellent" or "very good".

The study was conducted long before the Supreme Court hearings on the ACA law.  A similar study looking a Medicaid expansion in Oregon showed that the Medicaid recipients see doctors more often and report better health and better financial stability.

There is no doubt among experts that increasing insurance benefits and access to health care improves overall health.  Isn't that what we, as a Nation, want for our citizens?  Medicaid currently covers needy parents and children, low-income disabled people and the indigent elderly who need nursing home care.  The ACA calls for the expansion of Medicaid to lower-income childless adults.  Begining in 2012, Medicaid expansion in combination with the Affordable Care Act's state exchanges should allow most uninsured Americans to finally get affordable coverage.

Under the ACA, the Federal government will pay 100% of the cost for new expansion for the first 3 years, which declines to 90% by 2020.  Why would a State opt out and leave its own people with poor or no health care?  Texas and Florida are two States that refuse to expand Medicaid.  The biggest impact will be on low-income, uninsured women, about 2.4 million and 1.5 million, respectively.  They say they worry that the Feds will be under financial pressure to pay less over years to come.  I have an answer for that!!  We should elect officials that are committed to America's health and that don't look a health care as the first place to make budget cuts.

The fact that a Governor can look his/her citizens in the eye and say "Nope, we don't want to allow our lower income population to get affordable health care, EVEN THOUGH IT HAS NO ADVERSE EFFECT ON OUR STATE BUDGET" is deplorable.  Are we, as citizens, just asleep?  Do we not care because  this topic is just too complicated to understand? 

Are we proud to be a society that is comfortable spending $100 billion a year on wars in the Middle East but think spending $100 billion a year on health care is outrageous?  Our priorities are backward if we do.


Michael Kirsch, M.D. said...


No surprisingly, we are in complete agreement that ideally all citizens should have medical coverage. I do not think that the governors of states who choose to opt out are callous creatures. When they will be responsible for 10% of the cost of new Medicaid folks (10% of an uncertain number), they need to make the math work. Mamy states today are already underwater and sinking. Looks what's happening in your own state of California, for example. I don't think that their reluctance is from a moral lapse. I think its from a growing resource lapse.

Toni Brayer, MD said...

Michael Kirsch,MD, thanks for your thoughtful comment. Many economists believe the cost of NOT expanding is far more expensive in terms of cost shifting and isn't the goal really better health for all citizens? This study shows health coverage really does make a huge difference!

This recession is affecting all States. Healthcare for the poor should not be a partisan issue and I think it is indefensible.

That said, we really need to address rising costs, lack of primary care and payment structures that make the whole thing unsustainable anyway.

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