States that expanded their Medicaid programs were able to reduce their adult mortality rates by an average of slightly more than 6% in the five years after the expansion, according to a study published online Wednesday in the New England Journal of Medicine, the Wall Street Journal reports.
The study -- by researchers at the Harvard School of Public Health -- comes as states are deciding whether to take part in the Affordable Care Act's Medicaid expansion, after the Supreme Court's ruling last month made participation optional (Corbett Dooren, Wall Street Journal, 7/25).
For the study, researchers 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 (Alonso-Zaldivar, AP/Miami Herald, 7/25).
Researchers used data from CDC on adults ages 20 to 64 in the seven states, which covered five-year periods before and after the expansions (Krauskopf, Reuters, 7/25). According to the Journal, previous studies have suggested that expanding Medicaid can lower death rates in children, but similar research on adults was not available (Wall Street Journal, 7/25).
The new study found that broadening Medicaid eligibility in the three states lowered mortality rates from all causes by 19.6 deaths per 100,000 adults, or a 6.1% drop in death rates compared with the states that did not expand Medicaid. In addition, the study found that death rates declined the most among adults ages 35 to 64, minorities and residents in lower-income counties.
According to Reuters, the findings also showed that the expansions led to lower rates of uninsurance, lower rates of delayed care because of costs and an increase in individuals who reported their health status as "excellent" or "very good" (Reuters, 7/25).
The study's lead author Benjamin Sommers -- a physician and assistant professor of health policy and economics -- said he could not say "for sure that there is a cause-and-effect relationship" between the expansion and reduced death rates. However he said, "I can tell you we did everything we could to rule out alternative explanations" (Belluck, New York Times, 7/25).
Sommers and his team noted, "The fact that mortality changes were largest in expected subpopulations offers some reassurance that we have isolated the effect of Medicaid expansion" (Wall Street Journal, 7/25).
In an interview with NPR, Sommers said his research complements a landmark 2011 Oregon study that compared about 10,000 adult residents, who became eligible for Medicaid through a lottery program with those who did not. He noted that although his research is "not a randomized study," it used a larger sample -- more than 68,000 people -- and covered a longer period of time (Rovner, "Shots," NPR, 7/25).
Study Draws Mixed Reactions
The new study drew a mix of reactions from health advocates, economists and observers, the Times reports.
Karen Davis, president of the Commonwealth Fund, said, "I think it's a very significant study in part because of the paucity of studies that have really looked at health outcomes of insurance coverage," adding that it is "timely, adds to the evidence base, and certainly should raise concern about the failure to expand Medicaid coverage to people most at risk of not getting the care that they need."
Douglas Holtz-Eakin -- a former director of the Congressional Budget Office and president of the conservative American Action Forum -- said the study was "well done" and "brings more evidence in about the benefit side" of Medicaid. However, he expressed skepticism that the results could be generalized, the Times reports (New York Times, 7/25).
Critics of the study likely will note that Sommers currently is on temporary assignment in a policy division of HHS, the AP/Miami Herald reports.
However, Sommers said that "HHS does not have anything to do with this [study]," the study had started before he began serving as an adviser to HHS and that no federal funding was used for the research (AP/Miami Herald, 7/25). Officials at NEJM also said the study was conceived and drafted while Sommers was at Harvard (Wall Street Journal, 7/25).