Mortality and Access to Care among Adults after State Medicaid Expansions

 
The results of a 10-year, multi-state study offer new evidence that demonstrates that State Medicaid expansions to cover low-income adults were significantly associated with reduced mortality.
 
Published in last week’s New England Journal of Medicine, this study compared three states (New York, Maine, and Arizona) that substantially expanded adult (ages 20 -64) Medicaid eligibility since 2000 with neighboring states without expansion programs to examine whether Medicaid expansions were associated with changes in mortality and other health related measures.  Such expansion programs were associated with a relative reduction of 6.1% in mortality as well as improved coverage, access to care, and self reported health.
 
Medicaid currently insures 60 million people, and the Affordable Care Act (ACA) will extend Medicaid eligibility to millions more starting in 2014. Traditionally Medicaid covers only low income children, parents, pregnant women, and disabled persons. During the past decade several states have expanded Medicaid to cover nondisabled childless adults, a group similar to the population gaining eligibility under the ACA: all adults with income up to 138% of the federal poverty limit.
 
The recent U. S. Supreme Court ruling enables states to choose whether to expand Medicaid under the ACA or not. Many states are in fact contemplating cutbacks in Medicaid programs for budgetary reasons. Although a handful of states have unequivocally declared their intentions about expanding Medicaid (or not), others, including Tennessee, have yet to do so.
 
Evidence regarding Medicaid effects on the health of adults has been limited. The findings from this study -- that the expansion of Medicaid coverage may indeed reduce mortality among adults -- may influence State’s decisions with respect to Medicaid expansion under the ACA.
 
New England Journal of Medicine, September 14, 2012

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