Study links expanded Medicaid coverage with decline in mortality rates

States that chose to expand their Medicaid programs under the Affordable Care Act (ACA) have seen a decline in annual death rates, a new study has found. The study by researchers at the Keck School of Medicine at the University of Southern California (USC) was published in the December issue of The Lancet.

According to the study, among 32 expansion states and 17 non-expansion states, Medicaid expansion has been associated with nearly 12 fewer deaths per 100,000 adults annually.

“Using national data to look for results on a population level, we analyzed five federally-maintained registries covering states that have increased Medicaid access as well as those that have not,” said lead researcher Brian P. Lee, M.D., M.A.S., an assistant professor of clinical medicine at the Keck School of Medicine. “We found that Medicaid expansion exerts an influence on mortality rates – and the magnitude of benefit is correlated with the magnitude of expansion.”

The last point is notable: the difference in mortality rates varied from state to state. But overall, the research found that states that expanded their Medicaid programs have seen a decline in death rates—a finding that echoes 2019 research by the Center on Budget and Policy Priorities, which found that ACA Medicaid expansion saved the lives of at least 19,200 adults aged 55 to 64 over the four-year period from 2014 to 2017.

An effort to increase coverage among low-income Americans

The Medicaid expansion was one of the more controversial provisions of the ACA—and one that opponents thought might help get the law overturned by the Supreme Court. In a challenge to the ACA in 2012, a number of states joined a lawsuit challenging both the Medicaid expansion and the individual mandate provisions of the law.

The Supreme Court declined to invalidate the law completely but ruled that states could not be required to expand their Medicaid programs. Although more states joined over time, some states continue to reject the ACA Medicaid expansion program, effectively keeping their Medicaid programs at more restrictive levels of eligibility.

The analysis found that no matter what the status of the Medicaid program, a reduction in the uninsured population in states was generally associated with a reduction in mortality. “The findings suggest that increasing the number of people with health insurance is the mechanism driving the improvements in mortality associated with Medicaid expansion,” the researchers said.

Medicaid expansion reduces mortality among vulnerable populations

The USC study also found that certain groups were helped more by Medicaid expansion. African Americans and women—who statistically have higher poverty rates and lower rates of insurance coverage—were the populations most likely to benefit from the expansion.

“Our results suggest that interventions to Medicaid policy might have especially pronounced effects on racial and sex differences in health outcomes, which need careful consideration by policy makers,” the report said. “Also, as non-expansion (vs. expansion) states had a higher proportion of Black individuals, and the association between reduction in uninsured residents with decreases in all-cause mortality was independent of Medicaid expansion status, our analyses suggest that non-expansion states might have the most to gain from adopting Medicaid expansion.”

https://www.cbpp.org/aca-medicaid-expansion-improving-access-to-care-health-and-financial-security-research-finds