Friday, July 27, 2012

You may have read about a study published in the New England Journal of Medicine showing that in states that expanded Medicaid access more people were able to obtain health care and mortality decreased. The chart is a screenshot of one of the study's main findings, that compared to the five years before expansion, deaths per 100,000 non-elderly adults declined. (The study looked at the five years before and after expansion.) The study authors conclude:

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. . .
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. However, it is not clear whether the magnitude of these changes is sufficient to account for the observed mortality reduction, and these associations do not prove causality.
The study has some limitations - its results are driven by the New York State data. (New York is much larger than the other two states in the sample, Maine and New Mexico.) So the results may not be generalizable. Further, the methodology doesn't all the authors to draw any conclusions about causality. Still, it's a very interesting, and hopeful, study.

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