flickr image By Giant Sloth
Kill is a strong word. It's my word, not the word of a source or researcher. But it's the word that came to mind when I read reports of a Harvard study, reported in the New England Journal of Medicine. The study reported that there was a greater than six percent decline in death rate in states that expanded Medicaid.
Now, the study didn't say kill. It looked at mortality rates. I interviewed one of the authors of the study, Dr. Benjamin Sommers. Assistant Professor of Health Policy and Economics at Harvard School of Public Health, a health policy researcher and a primary care physician.
In our recorded interview, broadcast, August 1, on my Bottom Up Radio Show, on WNJC 1360 AM, Dr. Sommers described the study,
"...we were looking at Medicaid and we were looking at states that chose to expand Medicaid eligibility to low income adults in the early part of the 2000 decade and traditionally Medicaid only covers people in certain groups of eligibility-- disabled adults, low income children, parents and pregnant women. But these states took the step of voluntarily expanding to adults who did not have any children at home and don't have disability. These groups are sometimes called "childless adults," and among these low income "childless adults," most states in the U.S. just don't have any coverage available to them. But these states: Arizona, New York and Maine, took the step in 2001, 2002 to expand coverage to them.
And this is a real important experiment for us to look at because this is pretty similar to what the "Affordable Care Act" will do in 2014; expanding Medicaid to all adults up to 138% of the federal poverty level. And basically what we did then, in a study, is we looked at those three states and we compared to them to four neighboring states that didn't expand their Medicaid programs and we looked at the impact on several different outcomes.
First, we just looked at insurance coverage, then we looked at access to care, health and finally, most importantly, we looked at life expectancy or survival. And what we found was that in the states that expanded their Medicaid program compared to those that didn't, mortality--the death rate among adults 19-64 actually went down by about 6% per year over that period. And this translates into nearly 2800 deaths prevented per year in these states that expanded Medicaid."
This was pretty much a summary of what the New England Journal of Medicine study reported here: Mortality and Access to Care among Adults after State Medicaid Expansions
And that is pretty much what hundreds of newspapers and other news sources reported as well.
But between the lines, I read something else, as the headline states. I read that thousands of people almost certainly died because the expanded Medicaid was not implemented in the three "control group" states. I extrapolated to make a conclusion, and it's a leap, but not that big of one. When Obama's Affordable Care Act is put into place in 2014, when Republican governors refuse to accept 90% payment for Medicaid that is very similar to the programs assessed in the Harvard study, tens of thousands of people who would have lived may die because the governors refused coverage for them.
Another article reporting on the study stated,
The difference in mortality rates, if applied to Florida, would yield about 5,680 fewer deaths per year among under-65 adults, Health News Florida calculated last week.
That same article reports that the coverage will bring an additional $24 billion in federal funds into the state of Florida. But Governor Scott is concerned that Florida won't be able to pay the 10% that Florida will have to cover-- under $3 billion. If Florida gets $24 billion, then it's hard to imagine how Florida won't be able to recover that amount in taxes, money saved putting people to work with the $24 billion and money that gets recycled into the Florida economy.
But no-one, none of the sampling of the 100 articles reporting on the study that I viewed took the logical step of drawing some pretty ugly conclusions.