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WEDNESDAY, July 25 (HealthDay News) -- On June 28, the U.S. Supreme Court struck down part of a federal mandate to expand Medicaid as unconstitutional, but a new study suggests that widening access to the program would save lives.
The study, published online July 25 in the New England Journal of Medicine, looked at outcomes for three states that have already expanded access to the joint federal-state program, which helps many low-income people pay for health services.
According to the study authors, Arizona, Maine and New York each "substantially expanded adult Medicaid eligibility" before 2000 to include childless, poor adults, much as the 2010 Affordable Care Act seeks to do.
The researchers tracked state death statistics, levels of delays of medical care linked to a lack of insurance and residents' self-reported health during the five years before and after the expansion of the states' Medicaid programs.
They compared those numbers to rates from four neighboring states (Nevada, New Mexico, New Hampshire and Pennsylvania) that had not undertaken the same expansion of Medicaid for adults.
Overall, data on more than 429,000 people was included in the analysis.
Researchers led by Dr. Benjamin Sommers, assistant professor of health policy and economics at the Harvard School of Public Health in Boston, found that expansion benefitted state residents.
"State Medicaid expansions to cover low-income adults were significantly associated with reduced mortality, as well as improved coverage, access to care and self-reported health," they concluded.
Specifically, death rates fell by about 6 percent in states that expanded access to Medicaid, with older adults, nonwhites and the poor most likely to benefit. An extra 2.2 percent of the states' population gained access to health insurance, and nearly 3 percent saw reductions in delays for medical care linked to cost.
More residents said they felt better too. After Medicaid expansions in the three states, 2.2 percent more residents rated their health as "excellent" or "very good," the study found.
"The recent Supreme Court decision on the Affordable Care Act ruled that states could decide whether or not they wanted to participate in the health care law's Medicaid expansion," Sommers said in a Harvard news release. "Our study provides evidence suggesting that expanding Medicaid has a major positive effect on people's health."
In a journal commentary accompanying the study, two legal experts say the research shows the benefits to states of supporting the Affordable Care Act's provision to expand Medicaid.
"Several Republican governors had made a show of their adamant refusal to expand their Medicaid programs," wrote Timothy Stoltzfus Jost of Washington and Lee University School of Law in Lexington, Va., and Sara Rosenbaum of George Washington University School of Public Health and Health Services in Washington, D.C.
"The [Affordable Care Act] offers no other means for covering adults with incomes below 100 percent of the poverty level," the two experts noted. "Resisting states effectively intensify the huge uncompensated burden faced by their hospitals, deprive other health care industry players of important revenues and keep their medically underserved communities from receiving an enormous economic infusion."
Not everyone agrees, however, that the expansion of a public program is the smartest means of improving access to care.
"This seems like very solid research, and encouraging results. The question remains, however, whether Medicaid expansion is the best way to get the job done," said Greg Scandlen, director of the advocacy group Consumers for Health Care Choices. "The program is already under great stress, both in financial terms and in delivering health services. Would it have been better to use the same funds to get the same people into the private market? We can't know, but it would be worth studying."
Michael Cannon, director of health policy studies at the Cato Institute, a Washington, D.C., think tank, echoed those sentiments.
"These results are unsurprising, and do not imply that states should expand Medicaid," he said. "One would hope and expect that spending billions of dollars on Medicaid would save lives. The real question is whether this is the lowest-cost way of saving lives. I wonder if the authors tally the cost of those Medicaid expansions and see how much it cost per life saved."
The Harvard press release notes that Sommers "is currently working as an adviser in the Office of the Assistant Secretary for Planning and Evaluation at the U.S. Department of Health and Human Services. However, this paper was conceived and drafted while Dr. Sommers was employed at Harvard, and the findings and views in this paper do not represent the views of the Department of Health and Human Services."
-- E.J. Mundell
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