If the programs will pretty much pay for themselves and maybe even yield profits for the states, and bring in thousand or hundreds of thousands of jobs, why would Republican governors make a decision to withhold healthcare for the poor? I have to ask, and it's the reason I interviewed Dr. Sommers, is it reasonable to assume that thousands of people will die if the governors reject the funding?
Here's how my conversation with Dr. Sommers went:
Rob: So, that's three states. How many deaths would've been prevented based on these numbers if the control states--the ones that didn't implement the expanded Medicare, had implemented it.
Dr. Sommers: So, we didn't look directly at that and it's hard to extrapolate directly because the states that are expanding Medicaid and the ones that didn't are somewhat different. It's possible if the non-expanding states had done it, it would have had a different impact, but the population size is pretty similar in those other states and so we might expect a similar size affect; potentially several thousand lives saved each year.
Rob: That's phenomenal, isn't it?
Dr. Sommers: Well, yeah. It's good news. It's certainly--we would hope that if we're going to spend a lot of money on a program to provide insurance coverage to adults that it actually has some impact and it was encouraging to see both coverage went up and the number of uninsured adults went down as well as the number of adults who said they were unable to obtain medical care that they needed because of costs. That went down. So we were seeing barriers to care eliminated by the Medicaid expansion and then ultimately that seemed to translate into better health and better survival.
Rob: About how many people did this expanded Medicare reach to?
Dr. Sommers:: So, the expansion--I just wanted to clarify. Medicaid is the program for the poor and Medicare tends to be for the elderly, 65 and over and while they both are key programs, the one that's really at stake under the "Affordable Care Acts" expansion would be Medicaid.
Rob: / Okay. Okay.
Dr. Sommers: / And what we saw there in terms of the numbers who are enrolled, about half a million, about 500,000 adults signed up in these three states under this new, expanded eligibility.
Rob: Okay, half a million in your study in these three states that you've looked at, how many would be affected when the new health care program comes in?
Dr. Sommers: The national expansion under the "Affordable Care Act" was initially expected to happen in all 50 states plus the District of Columbia, and the predication from the Congressional budget office was that this would lead to about 16 or 17 million adults gaining insurance through Medicaid. Right now the situation's changed a little bit since the Supreme Court ruling, because the Supreme Court effectively gave states the option of whether or not they want to expand their coverage under Medicaid and so that number may be significantly lower if several states choose not to expand Medicaid and right now that's the big debate at the state level--is whether or not to accept the expansion.
Rob: What I'm trying to wrap my head around is that half a million people in this study got expanded coverage and it saved about 2500 lives, right?
Dr. Sommers: Yep.
Rob: So, if you extrapolate out to 16 or 17 million, it's going to be 32, 33, 34 times that. 75,000 or more people--lives will be saved.
Dr. Sommers: Your math is right. It's not necessarily clear that the overall national results would be exactly the same as what we saw at the state level and there are several reasons for that. One, is that, as I said each state is a little bit different in terms of how it runs its Medicaid program and who enrolls. So, it could be that other states won't have quite the same impact. And the other factor is that this federal expansion is actually going to be even bigger than the state ones were and so, while on the one it means you have more people enrolled, our suspicion is that the first people that sign up for Medicaid expansion are the ones who are the sickest, who really need help the most. And so as you start to add more people later on in a bigger expansion, they may not get quite as much bang for the buck, but still we'd expect to see a significant benefit. So, it's hard to fix it to an exact number but it certainly would be far greater than the 2500 we saw in just three states.