Medicaid makes for longer lives, study suggests

Better access to care also found in 3 states that expanded program

— As states consider whether to expand their Medicaid insurance programs under President Barack Obama’s healthcare law, new research details potential public-health effects of the decision.

A study published Wednesday in the New England Journal of Medicine indicates that residents of states that expand coverage will likely live longer.

Researchers at the Harvard School of Public Health who compared three states that voluntarily expanded their Medicaid programs over the past decade with neighboring states that did not found mortality rates were more than 6 percent lower in states with more generous coverage.

Residents of Arizona, Maine and New York also were less likely to delay needed care because of cost and more likely to report that they were in good health.

“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,” the authors said in their conclusion.

The lead author, Dr. Benjamin Sommers, is now advising the Department of Health and Human Services, but he wrote the article while at Harvard, according to a note accompanying the piece. He also stressed that his study wasn’t funded by the government.

Medicaid is a federal-state program for low-income and severely disabled people. It covers about 60 million people in the United States. The Patient Protection and Affordable Care Act that Obama signed two years ago assigned Medicaid a major role in expanding coverage, accounting for about half the 30 million uninsured people expected to gain insurance as a result of the health overhaul.

But the Supreme Court last month ruled that states have the leeway to reject the law’s Medicaid expansion, which is geared to reach mostly uninsured adults without children and with annual incomes up to about $15,400. As a consequence, the Congressional Budget Office projects 6 million fewer people will gain coverage through Medicaid. However, researchers estimated about 3 million people would gain private insurance coverage through health-insurance exchanges to be established in all states.

Republican Govs. Rick Scott of Florida, Rick Perry of Texas, Phil Bryant of Mississippi, Bobby Jindal of Louisiana and Nikki Haley of South Carolina say their states can’t afford to take part.

The study compared key health statistics in the three states that expanded Medicaid coverage to poor adults without children with outcomes in neighboring states that did not, examining five years before the expansion and the five years after.

New York, Maine and Arizona have all expanded eligibility for adults since 2000, with New York’s expansion by far the largest. States that did not expand and were used for the comparison included Pennsylvania (for New York), New Hampshire (for Maine), and Nevada and New Mexico (for Arizona.)

While the study is not the gold standard for statistical research because subjects were not selected at random, Sommers said the researchers cross-checked their results and are confident of the findings.

In addition to the drop in death rates among adults ages 20 to 64, the study found a 21 percent drop in delays getting care blamed on cost barriers.

The new study parallels the findings of a unique study of Oregon residents who won a lottery in 2008 to get Medicaid coverage, allowing researchers to compare them against a similar population that did not get coverage. The new enrollees in Oregon Medicaid also reported better health and better access to medical care.

Information for this article was contributed by Noam N. Levey of the Tribune Washington Bureau; by Ricardo Alonso-Zaldivar of The Associated Press; and by Alex Wayne of Bloomberg News.

Front Section, Pages 5 on 07/26/2012

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