Medicaid and mortality

A study (this is a pay site) has found (go here for the Boston Globe write-up):

Our study documents that large expansions of Medicaid eligibility in three states were associated with a significant decrease in mortality during a 5-year follow-up period, as compared with neighboring states without Medicaid expansions. Mortality reductions were greatest among adults between the ages of 35 and 64 years, minorities, and residents of poor counties.

This was a ‘natural’ experiment, because they were able to compare states that expanded their Medicaid coverage to states that did not. There are two major problems with the study: there was no randomization; they did not have access to individual data, so they could not see what happened to people whose coverage changed. The first problem makes it very difficult to show causality since there will always be unknown confounding factors (perhaps the Medicaid expansion was part of a general push by the states to improve healthcare and other parts of the campaign actually drove the mortality reduction, for example). The second one means that they can’t tell if the reduction occurred in the affected population and makes it difficulty to find a difference (the authors of the study note: A relative reduction of 6% in population mortality would be achieved if insurance reduced the individual risk of death by 30% and if the 1-year risk of death for new Medicaid enrollees was 1.9%–so the study barely finds a possible 30% reduction in mortality for those affected). Still, they did find:

Our secondary analyses provide a plausible causal chain for reduced mortality that is consistent with previous research, with eligibility expansions associated with a 25% increase in Medicaid coverage, 15% lower rates of uninsurance, a 21% reduction in cost-related delays in care, and a 3% increase in self-reported excellent or very good health.

It’s also consistent with studies that have found that the uninsured have an elevated risk of mortality.

There is a study on Medicaid that is randomized, but it’s not complete yet.

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