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New England Journal of Medicine Study Shows That States Which Expand Medicaid Save Lives

Of all the tips and tricks being trotted out by partisans and health care advocates to pressure Republican governors to accept the Medicaid expansion, this may be the most useful for moral purposes:

Into the maelstrom of debate over whether Medicaid should cover more people comes a new study by Harvard researchers who found that when states expanded their Medicaid programs and gave more poor people health insurance, fewer people died.

The study, published online Wednesday in The New England Journal of Medicine, comes as states are deciding whether to expand Medicaid by 2014 under the Affordable Care Act, the Obama administration’s health care law […]

The study, conducted by researchers from Harvard’s School of Public Health, analyzed data from three states that had expanded their programs in the last decade to cover a population not normally eligible for Medicaid: low-income adults without children or disabilities. The new law also expands coverage to a similar population nationally.

Researchers looked at mortality rates in those states — New York, Maine and Arizona — five years before and after the Medicaid expansions, and compared them with those in four neighboring states — Pennsylvania, Nevada, New Mexico and New Hampshire — that did not put such expansions in place.

The number of deaths for people age 20 to 64 — adults too young to be considered elderly by the researchers — decreased in the three states with expanded coverage by about 1,500 combined per year, after adjusting for population growth in those states, said Dr. Benjamin D. Sommers, a physician and an assistant professor of health policy and economics who was an author of the study.

So, if you want to round off, around 500 people in the average-sized state would die every year if they don’t expand Medicaid. With Texas being about four times the size of the average state, that means Rick Perry would be signing the death warrant of 2,000 of his citizens annually. And that’s a conservative estimate, because if you adjust for economic factors, the numbers go up by a factor of two, so it could be as many as 4,000 unnecessary deaths caused by Perry’s intransigence. Now, Rick Perry likes to sign death warrants, so this probably won’t represent much of a problem for him. But in this case, the “crime” meriting execution is an inability to afford health insurance.

I know, it’s crass, it’s crude, it’s just awful to say these things. But it’s also accurate. More people with access to Medicaid means less people without health insurance access. And a lack of access correlates strongly with mortality. Those are just the facts and we shouldn’t shy away from them. This is a very credible study that drilled down into the data as much as possible, and the alternative explanations brought up by conservatives here fall short.

While the data did not describe specific causes of death, researchers found declines in two broad categories of deaths — those caused by disease and those caused by accidents, injuries and drug abuse, possibly suggesting that even accident victims may get or seek more extensive care if they are insured.

“So often you hear, ‘Oh well, poor people just shoot each other, and that’s why they have higher mortality rates,’ ” said Diane Rowland, executive vice president of the Kaiser Family Foundation, a nonprofit group. “In the midst of many claims about what Medicaid does and doesn’t do, it actually shows that it cannot only be beneficial for health, but in preventing some of the premature deaths of the uninsured.”

This argument should be used on Democrats and Republicans in the states. States led by governors of both parties cut Medicaid this year, and Medicaid-cutting has become a popular sport in the states, given that it eats up a higher percentage of state budgets. But that comes at a cost in people’s lives. That shouldn’t be parallel to the debate, but central to it.

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David Dayen

David Dayen