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Mortality and Access to Care among Adults after State Medicaid Expansions as reported in the New England Journal of Medicine.
Our study period included 5 years before and 5 years after each state's expansion, with the postintervention period beginning the first full year after the expansion to cover childless adults and the preintervention period covering the immediately preceding 5 years. We selected as controls neighboring states without major Medicaid expansions that were closest in population and demographic characteristics to the three states with Medicaid expansions15: New Hampshire (for Maine), Pennsylvania (for New York), and Nevada and New Mexico (for Arizona).
Our estimate of a 6.1% reduction in the relative risk of death among adults is similar to the 8.5% and 5.1% population-level reductions in infant and child mortality, respectively, as estimated in analyses of Medicaid expansions in the 1980s.3,4 Our results correspond to 2840 deaths prevented per year in states with Medicaid expansions, in which 500,000 adults acquired coverage.15 This finding suggests that 176 additional adults would need to be covered by Medicaid in order to prevent 1 death per year.
In conclusion, our results offer new evidence that the expansion of Medicaid coverage may reduce mortality among adults, particularly those between the ages of 35 and 64 years, minorities, and those living in poorer areas. Ongoing research on the basis of randomized data13,45 will be invaluable in expanding on these findings. The Medicaid program is slated to expand coverage to millions of adults in 2014 under the ACA, though the recent Supreme Court ruling enables states to choose whether they will do so, and some states may instead consider program cuts. 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.
Our study period included 5 years before and 5 years after each state's expansion, with the postintervention period beginning the first full year after the expansion to cover childless adults and the preintervention period covering the immediately preceding 5 years. We selected as controls neighboring states without major Medicaid expansions that were closest in population and demographic characteristics to the three states with Medicaid expansions15: New Hampshire (for Maine), Pennsylvania (for New York), and Nevada and New Mexico (for Arizona).
Our estimate of a 6.1% reduction in the relative risk of death among adults is similar to the 8.5% and 5.1% population-level reductions in infant and child mortality, respectively, as estimated in analyses of Medicaid expansions in the 1980s.3,4 Our results correspond to 2840 deaths prevented per year in states with Medicaid expansions, in which 500,000 adults acquired coverage.15 This finding suggests that 176 additional adults would need to be covered by Medicaid in order to prevent 1 death per year.
In conclusion, our results offer new evidence that the expansion of Medicaid coverage may reduce mortality among adults, particularly those between the ages of 35 and 64 years, minorities, and those living in poorer areas. Ongoing research on the basis of randomized data13,45 will be invaluable in expanding on these findings. The Medicaid program is slated to expand coverage to millions of adults in 2014 under the ACA, though the recent Supreme Court ruling enables states to choose whether they will do so, and some states may instead consider program cuts. 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.
