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Study shows many thousands died without Medicaid expansion

Eddie Burkhalter

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Around 15,600 Americans died over a five-year period because they lived in states that chose not to expand Medicaid, according to a recent study. 

Between 2012 and 2017, those 15,600 or so Americans died because they didn’t have the same access to care as those living in states that expanded Medicaid, according to the study by the University of Michigan, published Monday by the National Bureau of Economic Research. 

Alabama is one of 13 states that hasn’t approved Medicaid expansion. Doing so would provide coverage for around 340,000  Alabamians, according to a separate study in January 2019 by the University of Alabama at Birmingham’s School of Public Health. 

Sarah Miller, the study’s lead author and assistant professor of business economics and public policy at the University of Michigan’s Ross School of Business, told APR Tuesday that while it might seem obvious that expanded healthcare improves health outcomes this study was the first to dig deep into specific demographic data and to show the real impact of Medicaid expansion. 

There have been studies that used death certificates to determine health outcomes for states that expanded Medicaid, but those studies used much smaller sample sizes weren’t able to look at demographics data, which shows a person’s income and whether they had health insurance, Miller said. 

“So that’s been a data challenge for researchers,” Miller said. 

Miller said they used U.S. Census Bureau survey data coupled with records from the Social Security Administration to better narrow the study’s focus to those who were eligible for Medicaid but who did not receive it. 

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Researchers found that before the Affordable Care Act allowed for Medicaid expansion states tracked similarly, but after ACA, the mortality rates started changing. 

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“At that point, we see mortality rates going down in the people in the states that opted to expand relative to the not expanding,” Miller said. 

The study noted a .13 percentage point decline in annual mortality, a 9.3 percent reduction over the sample mean, associated with Medicaid expansion.

Miller said previous studies have shown that expanded Medicaid leads to increases in the use of prescription drugs for things like diabetes and heart disease and increased cancer screenings and hospital visits, which improved health outcomes, but this study was the first to look at the entire U.S. population and dig deep into the data to determine those mortality rates. 

The Affordable Care Act, known as Obamacare, adopted in 2011 allowed states to expand Medicaid programs to low-income uninsured adults and children. 

Expanding Medicaid in Alabama would cost the state an estimated $168 million in the first year and $25 million every year thereafter, but the Alabama Hospital Association estimates that over four years the expansion would add $11.4 billion to the state’s economy, more than paying for its cost. 

Attempts to reach Alabama Hospital Association’s chief policy officer weren’t immediately successful Tuesday afternoon, but the association is also concerned over the closure of rural hospitals as a result of the state’s decision not to expand Medicaid. 

The association estimates that hospitals are about 84 percent more likely to close in states that do not expand Medicaid. In Alabama 13 hospitals, seven located in rural areas, have closed within the last eight years, according to the association. 

Anniston-based RMC Health System in 2018 closed the 104-bed acute care hospital RMC Jacksonville, citing financial troubles. The hospital opened as Jacksonville Medical Center in 1976. 

No bills were introduced during the last state legislative session aimed at expanding Medicaid.

ACAMortality

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