There are real world implications of going without health insurance coverage. One jarring statistic is the risk of death among the uninsured. Studies have shown a 25 percent higher risk of death when a person doesn’t have health insurance. There are many possible reasons for this difference: health insurance is important for providing greater access to medical care, health insurance leads to increased rates of preventative screenings, reduced likelihood of forgoing healthcare because of cost, and greater financial protections from medical bankruptcy. Medicaid is the Federal and State government insurance program for people of all ages whose income and resources are insufficient to pay for health care. Expanding Medicaid coverage was a key goal of the Affordable Care Act, and the subject of intense political debate. Many states opted to expand their Medicaid enrollees, many did not. As of September 2019, the Kaiser Family Foundation reports that 37 states (including DC) have adopted the Medicaid expansion and 14 states have not adopted the expansion. Evidence shows that Medicaid has played a key role in reducing the number of uninsured. An important question is whether Medicaid expansion has produced gains in health outcomes. Research findings on mortality provide some compelling evidence.
Remarkable research by Harvard University professor Benjamin Sommers and colleagues found that states that expanded Medicaid, even before the Affordable Care Act (ACA) was passed (e.g., Arizona, Maine, Massachusetts, and New York), achieved a significant decrease (6.1%) in mortality. Benjamin Sommers et al., also found that health reforms introduced in Massachusetts by Governor Mitt Romney, with similar provisions to the ACA that later became Federal law, resulted in a 2.9% decrease in mortality. A recent study by Vanderbilt University professor Jonathan Metzel (2019) applied the same analysis to mortality rates in the state of Tennessee, a state that had rejected Medicaid expansion. Over a four year period (2011-2015) Metzel showed that the political decision to reject Medicaid expansion came at a significant cost (two to five weeks of life for every Tennessean), and this cost was felt across all racial groups: between 1,863 and 4,599 black lives (37.1 days of life) would have been saved by expanding Medicaid coverage, and between 6,365 and 12,130 white lives (14.1 days of life) would have been saved. Real world implications indeed!
Peter Erwin, Ph.D.
Vice President Federal Health Transformation Services