Health and Medical News and Resources

General interest items edited by Janice Flahiff

Medicaid Expansion Could Cut Death Rate

ADAPT Medicaid Rally

ADAPT Medicaid Rally (Photo credit: SEIU International)

From the 25 July 2012 article at MedPage Today

Expanding Medicaid programs might actually reduce mortality in low-income adults, a three-state study found, calling into question states opting out of the Affordable Care Act’s (ACA) Medicaid expansion in light of last month’s landmark Supreme Court ruling.

All-cause mortality in New York, Maine, and Arizona dropped by 19.6 deaths per 100,000 adults — a 6.1% decrease (P=0.001) — over a 10-year period when Medicaid coverage was expanded, a study published online in theNew England Journal of Medicine found…

The ACA required states to expand Medicaid to cover all non-elderly, low-income persons with incomes below 138% of the federal poverty level starting in 2014. States who chose not to expand their Medicaid programs were penalized financially under the law.

However, the Supreme Court deemed that expansion requirement unconstitutional, meaning that states could now choose to opt out without a penalty. Since then, Republican governors in Texas, South Carolina, Florida, Louisiana and elsewhere have vowed to refuse the Medicaid funding.

To see if expanding Medicaid coverage resulted in improved health status, Sommers and colleagues examined data from large health surveys for adults ages 20 to 64 who were observed 5 years before and after Medicaid programs were expanded in New York, Maine, and Arizona. Those states expanded to cover childless adults between 2000 and 2005. Neighboring states without major Medicaid expansion — New Hampshire, Pennsylvania, Nevada, and New Mexico — were used as controls.

The study found new enrollees were older, disproportionately minorities, and twice as likely to be in poor health as the general population, all suggesting higher mortality.

Results also were adjusted to account for economic measures that could have caused states to expand Medicaid when economies where thriving which could cause a spurious correlation between health and expansion.

Tim Sweeney, health policy director for the nonprofit think tank Georgia Budget and Policy Institute, told MedPage Today in an interview that the Sommers study confirms that access to health insurance makes people healthier. “It can’t do anything but help in the perspective of helping states move forward in their decision making,” Sweeney said.

The ACA includes coverage of 100% of the cost of expanded coverage for the first 3 years, dropping down to 90% by 2020. That federal backing allows participating states to cover thousands of low-income residents with little investment, and hospitals and doctors could see a drop in uncompensated care they provide.

“Resisting states effectively intensify the huge uncompensated care burden faced by their hospitals, deprive other healthcare industry players of important revenues, and keep their medically underserved communities from receiving an enormous economic infusion,” the perspective stated….

,,,There are several limitations to the study, Sommers admitted. Mortality data couldn’t be controlled for characteristics other than race, sex, or age. Also, the data were largely driven by New York, so results may not be generalizable to other states. Lastly, the nonrandomized design cannot control causality.Even for think tanks like Sweeney’s, it’s hard to tell how many new patients doctors could treat because many already access care now without Medicaid, Sweeney said.

Sommers reported he had no conflicts of interest. One of his co-authors reported relationships with Eli Lilly, the Medicare Payment Advisory Commission (MedPAC), Strategy 1, Campbell Alliance, TIAA-CREF, and Geraon Lehman.

The editorialists reported they had no conflicts of interest.

July 27, 2012 - Posted by | Public Health | ,

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