Does Expanding Medicaid Save Lives?

According to this recent paper by Ben Sommers, et al, in The New England Journal of Medicine, the answer is yes. Sommers and coauthors examine mortality before and after medicaid expansions in certain states, using the same before-after comparison in neighboring states as a control to account for general trends in mortality that would exist without Medicaid changes. They find expansions "were associated with a significant reduction in adjusted all-cause mortality (by 19.6 deaths per 100,000 adults, for a relative reduction of 6.1%; P=0.001)...Mortality reductions were greatest among older adults, nonwhites, and residents of poorer counties." They also find evidence of better self-reported health and reduced delays to getting care with Medicaid expansions.

This is a well done, timely piece. The recent Supreme Court ruling declared the provisions in the Affordable Care Act (ACA) decreeing mandatory Medicaid expansions to be unconstitutional. This has led some state governors to announce that they will not pursue such expansions. Some of this, of course, is dumb election year posturing: the ACA increases the Federal fund matching rate for Medicaid by a great deal, so governors will most likely buy in to the expansions because of these nice financial incentives. That said, this piece provides another angle to this whole debate, as failure to expand Medicaid may not just mean money left on the table, but people's lives as well.