Study: Medicaid may lower death rates

July 26, 2012

If there's one common gripe about Medicaid - aside from its growing price tag - it tends to be about the program's quality. "Medicaid coverage is worse than no coverage at all," one Wall Street Journal op-ed declared last year. Sen. Robert Corker  (R-Tenn.) dubbed the entitlement program the "worst health care system in America." Sen. John Cornyn (R-Tex.) did him one better, describing Medicaid as a "health care gulag."

There's just one small problem with these claims: A growing body of research is suggesting they aren't true. And the most recent piece of evidence is a study in the New England Journal of Medicine, published Wednesday, finding Medicaid expansions to be associated with lower state death rates.

The study comes just as governors weigh whether they will participate in the health law's Medicaid expansion, slated to begin in 2014.

Researcher Benjamin Sommers, Katherine Baicker and Arnold Epstein looked at three states - New York, Maine and Arizona - that substantially expanded Medicaid coverage for adults and compared their mortality rates against neighboring states that left coverage untouched.

Medicaid enrollment, unsurprisingly, went up: States saw their Medicaid enrollment spike upwards, with the program becoming 24.7 percent larger. The new enrollees were disproportionately older than the general population and tended to rank themselves in "fair" or "poor" health.

The really important finding here, however, has to do with mortality rates. The expansion states saw their mortality rate for for the all adults in the state - not just the new Medicaid patients - drop by 6.1 percent. Here's what that looks like in graph form:

 

 

"Our results correspond to 2840 deaths prevented per year in states with Medicaid expansions, in which 500,000 adults acquired coverage," the researchers write. Put differently, expanding Medicaid to 176 people would be expected to save one additional life. If you estimate that the cost of extending to Medicaid to one person is about $6,000 - as the Congressional Budget Office does - that works out to a $1 million investment for each death prevented (thanks to Incidental Economist for crunching those numbers).

Sommers, Baicker and Epstein point out that their results aren't a perfect analogy for the health law's Medicaid expansion. For one thing, they could not control which states expanded Medicaid - there may have been something else that sets New York, Maine and Arizona apart from the non-expansion states that could cause a "spurious" connection.

There are, however, some indications that the researchers are on the right track. Their findings align with studies that previously looked at Medicaid expansions in the 1980s, and found similar reductions in mortality. A study published earlier this year, looking at Oregon's Medicaid expansion, found that new enrollees reported feeling in better health and less financial strain compared to those who had applied for coverage but not obtained a spot.

The most telling piece of research, however, may still be forthcoming. The team of health care economists studying the Oregon experiment plan to publish new research that looks at actual health metrics, things like blood pressure and rates of diabetes. That's important because it will show how the health of individuals on Medicaid is actually changing in a way that's more objective than individuals' reporting of their own health. That study, researchers say, is expected to be published by the end of this year.

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Ezra Klein | July 26, 2012