It’s always important to confirm or disprove our priors with high quality research, and in this light, the NYT’s coverage of a new study showing the positive impact of Medicaid coverage is worth reading. The study looks mainly at mortality rates, but also health coverage, access to treatment, and general health outcomes, comparing outcomes in states that expanded coverage to childless adults to neighboring states that did not.
Dedicated OTE’ers will recognize this as the beloved difference-in-difference test, a pseudo-experimental design where you net out the impact of a policy intervention by comparing (in this case) states that got the intervention with states that are otherwise similar, but were not subject to the policy change.
Researchers looked at mortality rates in [three] states — New York, Maine and Arizona — five years before and after the Medicaid expansions, and compared them with those in four neighboring states — Pennsylvania, Nevada, New Mexico and New Hampshire — that did not put such expansions in place.
The number of deaths for people age 20 to 64 — adults too young to be considered elderly by the researchers — decreased in the three states with expanded coverage by about 1,500 combined per year, after adjusting for population growth in those states,
When researchers adjusted the data for economic factors like income and unemployment rates and population characteristics like age, sex and race, and then compared those numbers with neighboring states, they estimated that the Medicaid expansions were associated with a decline of 6.1 percent in deaths, or about 2,840 per year for every 500,000 adults added.
While the data included all deaths, not just deaths of Medicaid recipients, the decline in mortality was greatest among nonwhites and people living in poorer counties, groups most affected by expanded Medicaid coverage.
All good to know. But really, how big a surprise is this? If you’re poor in America, even with a job, your access to health care is, absent Medicaid, severely constrained. For workers in the bottom decile of the wage scale, only 11% are covered through the job, compared to 76% in the top 10%. That’s why when I was a social worker with poor families in NYC—admittedly decades ago—Medicaid wasn’t called “Medicaid” in the poor community—it was called “the gold card.”
Apparently, one of the motivations for the research is the right wing meme—and I must admit, this one somehow eluded me—“…critics, primarily conservatives, contend the program does not improve the health of recipients and may even be associated with worse health.”
Like I said, I’m glad to have this excellent research on hand, and I hope state officials consider it when considering the expansion of Medicaid coverage under the AHA. The problem here is that critics who make such patently silly claims like being on Medicaid makes you sicker are not likely to be moved by the finding that it actually helps keep you alive.