- Medicaid coverage reduces mortality rates among low-income adults ages 55-64, a group with relatively high mortality rates, a new study from the nonprofit National Bureau of Economic Research suggests. The research adds to a body of evidence connecting Medicaid coverage to health and access-to-care benefits for vulnerable people.
- The study's researchers compared mortality rates from 2014-2017 among pre-Medicare low-income adults in states that expanded Medicaid through the Affordable Care Act with their counterparts in states that didn’t expand Medicaid.
- The researchers estimated that 15,600 deaths would have been avoided during this four-year period if all states had expanded Medicaid.
To complete the analysis, the researchers followed the status of 566,000 de-identified people from 2014, the first year of expanded Medicaid, through 2017. Tapping into two federal databases, they compiled data on income, citizenship status, participation in government-funded social programs, and date and location of deaths.
Using databases that link information on socioeconomic status with death records, the researchers determined which individuals in their study population would likely qualify for Medicaid through the expansion.
They found a 0.13 percentage-point decline in annual mortality associated with Medicaid expansion. The results of their analysis also suggest that the impact of Medicaid expansion increases over time. By 2017, the individuals in expansion states had a mortality rate that was 0.2 percentage points lower than their counterparts in non-expansion states.
The new study adds to other research connecting Medicaid expansion to improving care for vulnerable people.
For example, a report from The Commonwealth Fund found that community health centers in states that expanded Medicaid saw improvements in their financial stability and ability to provide affordable care compared with their counterparts in states that didn't expand Medicaid.
The more than 11,000 community health centers spread across the United States provide a safety-net for low-income people seeking medical care.
Other recent studies credited Medicaid expansion with improving people's health, lowering maternal mortality rates, and reducing barriers to care.
Under the ACA, states can expand Medicaid coverage to people below 138% of the federal poverty level. Before the expanded eligibility rules, primarily children, pregnant women, adults with disabilities, and some very low-income parents qualified for the program.
Currently, 37 states have adopted Medicaid expansion — at least partially — and 14 states haven't. Nearly 14 million people have been added to Medicaid through the ACA.
While primarily Democratic-leaning states expanded Medicaid through the ACA in the early years, more recently, Republican-leaning states have at least considered expansion.
However, many of these plans partially expand Medicaid, which is possible if CMS approves a Section 1115 demonstration waiver. The waivers allow states to deviate from the federal rules for health and welfare programs, including Medicaid.
For example, seven states have tied Medicaid eligibility to meeting work requirements, which tends to reduce the number of people who qualify for the program. Another eight states have requested waivers to add the work requirements, including both expansion and non-expansion states.
Meanwhile, the future of Medicaid expansion is in doubt, as the latest legal challenge to the constitutionality of the ACA plays out in the federal court system. The U.S. Court of Appeals for the Fifth Circuit heard from lawyers recently in a suit brought by Texas and joined by 17 other states. Trial judge Reed O'Connor of the U.S. District Court for the Northern District of Texas invalidated the entire law late last year. He ruled the entire law was unconstitutional after Congress zeroed out the law's individual mandate penalty in 2017.