While a recent blog (“There is More to Life Than Death”) referred to the complexity of population-based medical decisions when relying solely on mortality, clearly mortality matters a lot. In the same NEJM issue, an article highlights the difference that expanded Medicaid coverage has on mortality in adults (NEJM 2012; 367: 1025).
Traditionally, Medicaid has covered only low-income children, parents, pregnant women, and disabled persons. In the past decade, several states expanded coverage to include nondisabled adults without dependent children. This study examined these efforts in three states (New York, Arizona & Maine). Then, effects on mortality were examined from 1997-2007 in these states as well as bordering states who did not expand coverage. This time period allowed data to be analyzed five years prior to change and five years afterwards.
- By broadening eligibility requirements, there was a 25% increase in Medicaid coverage.
- States with Medicaid expansions reduced all-cause mortality by 19.6 deaths per 100,000 adults; this was a relative reduction of 6.1%.
- Mortality reductions were greatest for older adults (35-64), nonwhites, and residents of poorer counties.
- The authors note that these changes do not prove causality. However, there are implications for the affordable care act which allows expansion of eligibility up to 138% of the federal poverty level.
Despite apparent improvement in mortality, the cost, logistics and politics of expanding medical coverage remain unclear. In Georgia, the decisions on expanding medical coverage are quite controversial (see links below). My view: I think everyone in this country needs at least basic medical coverage. This saves lives.