Rob: Now, there are some states that are talking about not signing up, like Texas, I believe. Right?
Dr. Sommers: Yep. At least five or six states that their governor's have said they think they're unlikely to do the expansion.
Rob: So, what your study suggests, it seems to me, would you agree, is that if these governor's decline to sign to up, potentially thousands of people in their state are going to die that might not have died because the study shows it?
Dr. Sommers: You know, it certainly--that's--our findings provide evidence that expanding Medicaid saves lives and so if a state chooses not to do that we would definitely be worried that they're leaving some adults without any coverage who will have worse health and some who will die prematurely. So, that's certainly the policy implication--one of the key policy implications of our study and we think that this is really useful evidence for states to take into account.
Rob: Now, you kind of danced around that a little bit. Not exactly, but are you uncomfortable saying it, that if a governor decides not to implement this policy people will die? That your study suggests strongly that people will die?
Dr. Sommers: Our studies certainly suggest that it--I think one of the things I'd say you have to be careful about is, like I said, states are different, you know very different policies and if a state said, "No," to the Medicaid expansion but found another way to get coverage to this many people or found another way to improve health care access for this many people, it might that it could be effective.
Unfortunately, my suspicion is that states that are not going to do the Medicaid expansion are probably not going to be able to afford to do another major change to their health care system, because the Medicaid expansion is so heavily funded by the federal government and most state budgets right now can't really afford to do anything on their own.
So, you do hear a little hesitation in my voice which is to say definitively there's going to be people dying in these states is a--that's suggested by our findings but I always do try to take the broader context in mind that there are others factors that would affect how the health of the population would be impacted. But certainly I would agree with the statement that expanding Medicaid seems to both improve access and health and even survival for long term adults.
Rob: Now, what are those other factors?
Dr. Sommers: So, one of the big factors that can vary quite a bit across states is, "What happens to people who don't have health insurance? Is there any kind of safety net pool in place that some states have set aside funds for? Are there federally qualified health centers that are pledged to taking care of patients without health insurance, regardless of their ability to pay? Or are people really more left to the charity of individual providers and if they can't find someone willing to treat them, often will delay care until the last possible minute when it's sometimes too late to really help?"
Rob: So, what are some of the states that are talking about not taking this program? One of them is Texas. What are some other ones? Florida?
Dr. Sommers: The governor of Florida has suggested it that Florida probably won't participate. Louisiana, Wisconsin, South Carolina have all had statements from the governor's office suggesting that they are probably not going to implement the Medicaid expansion.
Rob: Now are you aware of the kinds of programs that are available and what is going on in those states? How would you expect this to affect the people in terms of the results of your study?
Dr. Sommers: Well, those are states that have some very different programs in place. Wisconsin, for instance has traditionally had a fairly generous Medicaid programs and has actually covered some of the adults we're talking about, whereas Texas and Florida have not done so. South Carolina has not done that. And there are large numbers of low income, uninsured people in Texas and Florida in particular. These are states that have some of the highest concentrations of people who would potentially benefit from a Medicaid expansion. So, I do think that those states really have, in a lot of ways, some of the greatest potential gain by signing up and choosing not to expand Medicaid would, on the other hand, have some of the greatest missed opportunities to save lives for their low income population.
Rob: So, of the states that have spoken about not accepting the ObamaCare, the ACA, Florida and Texas are more likely to be ones where there will be a higher number of deaths that could be attributable to not having the insurance available to the poor?
Dr. Sommers: Yeah, if you take that our findings would work--would show a similar impact in Texas and Florida, which is, I think a reasonable assumption, then yes, it would be likely that a large number of uninsured people in these states that can't get covered would suffer the adverse health outcomes including higher death rates."