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.

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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.

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.

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."

 

There's no doubt that we are dealing with statistics here. Dr. Sommers has made it clear, in other interviews, that he cannot state, unequivocally, that there was a causal connection. But you've read what he says. People will most likely die in states where Republican Governors refuse to accept 90% funding for expanded coverage for the poor.

The Rght has talked about death panels. Maybe we should be talking about Killer governors, or Death governors. Frank Luntz, the GOP's language meister can tease out, with focus groups, which is more or less detrimental. Then we can talk about the poison tea party policies, or Death Sentence for the Poor Tea Partiers.

There's another consideration too. In Florida, there's another effect from allowing 6000 people under the defined, close to poverty lines to die. They won't vote. There's no need to require them to have voter IDs.  Okay. Maybe I'm going a bit over the top on this one. But bear with me. If  Governor Rick Scott in Florida, Rick Perry in Texas, and governors in South Carolina, Wisconsin and elsewhere actually go ahead with their threats to refuse the expanded coverage the ACA brings, over a four year period, Florida will have taken almost 23,000 voters out of the picture. Nationwide, if enough Republican state governors line up with Scott and Perry, over 300,000 close to poverty potential voters could be permanently taken off the voter rolls.

Even without my expedition into over the top voter purge speculation, the idea of governors making decisions that will likely lead to the deaths of thousands is heinous. What's even sadder is that they are doing it because the American political situation has become so toxic that these politicians think that this is what voters want. Worse, there are many on the right who actually don't care and don't feel any responsibility for these likely deaths.

Hopefully, the Governors will see the study and change their minds, and not quite literally, but very likely, grant reprieves to thousands of people who would otherwise die. If they fail to do so, then it's not unreasonable to say that the deaths of those people are on the governors' hands. 

Authors Bio:

Rob Kall is an award winning journalist, inventor, software architect,
connector and visionary. His work and his writing have been featured in the New York Times, the Wall Street Journal, CNN, ABC, the HuffingtonPost, Success, Discover and other media.

Check out his platform at RobKall.com

He is the author of The Bottom-up Revolution; Mastering the Emerging World of Connectivity

He's given talks and workshops to Fortune
500 execs and national medical and psychological organizations, and pioneered
first-of-their-kind conferences in Positive Psychology, Brain Science and
Story. He hosts some of the world's smartest, most interesting and powerful
people on his Bottom Up Radio Show,
and founded and publishes one of the top Google- ranked progressive news and
opinion sites, OpEdNews.com

more detailed bio:

Rob Kall has spent his adult life as an awakener and empowerer-- first in the field of biofeedback, inventing products, developing software and a music recording label, MuPsych, within the company he founded in 1978-- Futurehealth, and founding, organizing and running 3 conferences: Winter Brain, on Neurofeedback and consciousness, Optimal Functioning and Positive Psychology (a pioneer in the field of Positive Psychology, first presenting workshops on it in 1985) and Storycon Summit Meeting on the Art Science and Application of Story-- each the first of their kind. Then, when he found the process of raising people's consciousness and empowering them to take more control of their lives one person at a time was too slow, he founded Opednews.com-- which has been the top search result on Google for the terms liberal news and progressive opinion for several years. Rob began his Bottom-up Radio show, broadcast on WNJC 1360 AM to Metro Philly, also available on iTunes, covering the transition of our culture, business and world from predominantly Top-down (hierarchical, centralized, authoritarian, patriarchal, big) to bottom-up (egalitarian, local, interdependent, grassroots, archetypal feminine and small.) Recent long-term projects include a book, Bottom-up-- The Connection Revolution, debillionairizing the planet and the Psychopathy Defense and Optimization Project.

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Rob was published regularly on the Huffingtonpost.com for several years.

Rob is, with Opednews.com the first media winner of the Pillar Award for supporting Whistleblowers and the first amendment.

To learn more about Rob and OpEdNews.com, check out A Voice For Truth - ROB KALL | OM Times Magazine and this article.

For Rob's work in non-political realms mostly before 2000, see his C.V.. and here's an article on the Storycon Summit Meeting he founded and organized for eight years.

Press coverage in the Wall Street Journal: Party's Left Pushes for a Seat at the Table

Talk Nation Radio interview by David Swanson: Rob Kall on Bottom-Up Governance June, 2017

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