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31-07-2012 | Article

Medicaid expansion improves care, saves lives

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MedWire News: Medicaid expansion, a key component of the Affordable Care Act (ACA), improves healthcare access for the poor and uninsured, and saves lives, a new study says.

A comparison of three US states that have expanded Medicaid eligibility for adults since 2000 with neighboring states that did not expand their Medicaid programs shows that greater access to care was associated with a significant, 6.1% reduction in all-cause mortality, report investigators in The New England Journal of Medicine.

"Our results offer new evidence that the expansion of Medicaid coverage may reduce mortality among adults, particularly those between the ages of 35 and 64 years, minorities, and those living in poorer areas," write Benjamin Sommers and colleagues from the Harvard School of Public Health in Boston, Massachusetts.

An accompanying editorial notes that the US Supreme Court's June 28 ruling on the ACA essentially makes Medicaid expansion a state-by-state option for newly eligible adults.

"But some states may press the administration to interpret the expansion as a simple state option, allowing them to cover some portion of the expansion group and not others. This approach has no support in the law and would invite states to leave the most vulnerable members of the expansion group - adults without children - exposed to the worst sort of discriminatory exclusion," write Timothy Stoltzfus Jost (Washington and Lee University School of Law, Lexington, Virginia), and Sara Rosenbaum (George Washington University School of Public Health and Health Services, Washington, DC).

Sommers and colleagues examined all-cause mortality and other data on adults from the ages of 20 through 64 years from 5 years before, to 5 years after Medicaid expansion in New York, Maine, and Arizona. The data were compared with those of control states with similar populations and demographics but without Medicaid expansion: Pennsylvania, New Hampshire, and Nevada, respectively.

The researchers found that Medicaid expansions were associated with a reduction in all-cause mortality of 19.6 per 100,000 adults, which translated into a significant relative reduction of 6.1% compared with no expansion.

The mortality reduction benefits were greatest for older adults, non-Whites, and residents of counties with lower per-capita incomes.

States with program expansions saw an absolute increase of 2.2% in both Medicaid coverage and in the rate of patients reporting their health status as "excellent or very good," (significant relative increases of 24.7% and 21.3%, respectively). They also saw decreases in the rate of uninsured individuals, and those delaying care because of an inability to pay, with absolute reductions of 3.2% and 2.9%, and significant relative reductions of 14.7% and 21.3%, respectively, compared with states with no expansion.

"Policymakers should be aware that major changes in Medicaid - either expansions or reductions in coverage - may have significant effects on the health of vulnerable populations," Sommers et al conclude.

By Neil Osterweil, MedWire Reporter