Prior to Medicaid expansion, the study finds, mortality trends among low-income older adults were similar in states that would and would not later expand Medicaid. The large sample lets them detect small changes in mortality that aren’t evident in other data. Second, they construct a novel dataset that links the American Community Survey - the largest federal survey with information on income, age, and other determinants of Medicaid eligibility - with administrative death records. First, as noted, they focus on older adults, who have higher mortality rates overall and are at greater risk of premature death from treatable conditions. The authors overcome this challenge in two ways.
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This means that even sizable reductions in health-care-amenable mortality are hard to detect in most data sets. Figure 2Ī challenge in assessing the impact of Medicaid expansion on mortality is that mortality rates among non-elderly adults are low (about 33 deaths per 10,000 people each year), and only a fraction of those deaths are from “health-care-amenable” causes - preventable deaths that better medical care could help avoid (for example, from heart disease or diabetes) - versus causes less amenable to treatment (such as car accidents). The new study, by Sarah Miller, Sean Altekruse, Norman Johnson, and Laura Wherry (researchers at the University of Michigan, National Institutes of Health, Census Bureau, and University of California Los Angeles, respectively), compares mortality rates among 55- to 64-year-olds likely eligible for Medicaid in expansion states to mortality rates among similar older adults in non-expansion states. Sharp Drop in Premature Deaths After Expansion It should also finally put to rest claims that Medicaid doesn’t provide quality coverage, such as Center for Medicare & Medicaid Services (CMS) Administrator Seema Verma’s suggestion that Medicaid expansion gave low-income adults “a card without care.” On top of the already well-documented gains in access to care and financial security, the new study shows that gaining Medicaid coverage is literally a matter of life and death, particularly for people with serious health needs. This new evidence that thousands of lives are at stake should give states that have not yet expanded Medicaid one more reason to do so. The new study finds particularly clear evidence of a drop in mortality from conditions like these, which are amenable to medication and other treatment. For example, research shows that Medicaid expansion increased the share of low-income adults using medications to control chronic conditions like heart disease and diabetes.
But its findings are consistent with a large body of research that has already documented that Medicaid expansion improves access to care and health outcomes. The new research fills a void, using a novel dataset to document sizable declines in mortality that smaller surveys could not detect. (See Figure 1 see Table 1 for state-by-state estimates.) The lifesaving impacts of Medicaid expansion are large: an estimated 39 to 64 percent reduction in annual mortality rates for older adults gaining coverage. Conversely, 15,600 older adults died prematurely because of state decisions not to expand Medicaid. It saved the lives of at least 19,200 adults aged 55 to 64 over the four-year period from 2014 to 2017.
“The lifesaving impacts of Medicaid expansion are large: an estimated 39 to 64 percent reduction in annual mortality rates for older adults gaining coverage.”The Affordable Care Act’s (ACA) expansion of Medicaid to low-income adults is preventing thousands of premature deaths each year, a landmark study finds.
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