Today’s Managing Health Care Costs Number is 3163
Source of Medicaid expansion eligibles: Kaiser Family Foundation
Source of mortality savings from insurance expansion: Annals of Internal Medicine
Julia Belluz coverage in Vox.com Interview with Benjamin Sommers
Note Wisconsin provided benefits to those with income up to 133% of FPL prior to ACA, and data on eligibility from Maine is not available
A policy decision made by 19 state governments might lead to more deaths each year than the number of Americans who died at the World Trade Center, in the Pentagon, and in the cornfield in rural Pennsylvania during the 9-11 terrorist attacks.
Harvard researchers looking at the experience of Massachusetts’ health care reform estimate one prevented death for every 830 who gain insurance. But 864,000 Texans, 467,000 Floridians, and 309,000 Georgians are not covered by the Affordable Care Act’s Medicaid expansion since the Supreme Court gave states the ability to opt out. This research suggests that expanding Medicaid coverage to the 2.6 million who would be eligible in states that have resisted Medicaid expansion could save 3163 lives each year. (Note that the numbers in the bar chart above add up to less than this due to rounding).
2997 people died in the 9-11 terrorist attacks.
Failure to expand Medicaid is a special problem because those under 133% of the Federal Poverty Level are ineligible for subsidies to purchase health insurance on the ACA exchanges. Many states that did not expand Medicaid offer no chance for those without young children to qualify for Medicaid; in a few states, the threshold for even young parents to qualify for Medicaid is 18% of the FPL – or $3600 annual income for a family of 3!
Expanding Medicaid is also incredibly inexpensive. The federal government pays 90-100% of the cost of expansion – and some calculations suggest that state tax collection alone could fully fund the state portion of the bill. Medicaid pays low provider rates – and the average cost of Medicaid expansion has been $2700*. So even the federal investment to provide this additional coverage would be pretty modest too.
This is just a projection – and the Massachusetts research is not necessarily totally applicable to other states. Researchers considered all expansion (not just Medicaid), and medical care in Massachusetts was readily available to the newly covered; that might not be true in some rural areas. On the other hand, Sommers’ research showed that improvement in mortality in Massachusetts was highest where the pre-reform uninsured rate was higher and where income was lower. This sounds like the populations in many of the nonexpansion states, so this projection might be too low.
Perhaps failure to expand Medicaid hasn’t cost 10,000 lives since 2014. But it’s hard to argue that lives have not been lost by the short-sighted decision not to expand Medicaid.
*Calculation of cost of adults and children:
Total on Medicaid: 68 million (3/4, or 51 million, are adults and kids)
Total Medicaid Cost: $397.6 billion. (36%, or $140 billion, spent on adults and kids)
$140b/51m enrollees ~=$2700 per enrollee
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