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Harvard Study: Death Rates Fall in Medicaid-Expanding States Like Maine
07/26/2012   Reported By: Jay Field

Death rates in Maine, and two other states that expanded Medicaid coverage over the past decade, fell by more than 6 percent, according to a new paper published in the New England Journal of Medicine. The study, by a Harvard researcher and two colleagues, comes as states across the country debate whether to go along with a nationwide expansion of Medicaid, as part of President Obama's health care law.

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What happens when a state actually expands Medicaid coverage and offers it to all low-income adults? There was virtually no body of research that answered this question when Congress passed the Affordable Care Act. So shortly after President Obama signed it into law, Benjamin Sommers and two colleages decided to try to fill in some of the knowledge gaps. Sommers is an Assistant Professor of Health Policy and Economics at the Harvard School of Public Health.

"So the study looked at 10 years worth of data--five years before and five years after the three states that expanded Medicaid to this group of low income adults in New York, Arizona and Maine, and then the four comparison states, their neighboring states, that had not made similar expansions in their Medicaid programs," Sommers says.

Sommers says adult death rates in Maine, New York and Arizona fell by more than 6 percent. The research also found lower rates of uninsurance, more low-income people reporting their health to be "good" or "excellent" and less delayed medical care due to costs.

"While the results certainly make sense and can seem fairly straightforward---that insurance helps---it's something that we didn't know and really is an important policy question to have answered with good evidence," he says.

The question now is what impact, if any, this new research is likely to have on the debate over Medicaid expansion in Maine and other states? As many as six Republican governors have said their states will opt out of any expansion, due to how much it will cost. In its ruling upholding the Affordable Care Act, the U.S. Supreme Court affirmed their right to do so.

But Gov. Paul LePage says the high court actually gave Maine the authority to go a step further and drop people from the rolls by streamlining eligibility rules for MaineCare. Prominent Democrats, like Congresswoman Chellie Pingree, and the Obama Administration dispute this. The LePage administration could not be reached for comment by airtime.

But Joel Allumbaugh says the Harvard study, though valuable information to have, asks the wrong question. Allumbaugh runs the Center for Health Reform Initiatives at the conservative-leaning Maine Heritage Policy Center. "If the goal of Medicaid is to save lives, is it saving lives in the most cost effectice manner?" he says.

Allumbaugh says no. He says Maine can get more bang for its buck by sending the millions and millions of dollars it spends on Medicaid to more specialized preventive services.

"There are certain key chronic conditions that I know are the leading cost drivers for health care in Maine: diabetes, asthma, coronary artery disease, chronic obstructive pulmonary disease, and I think, congestive heart failure are the top five," he says. "You know, there are a number of things we could do to target those specific populations around education, diet, medication management."

But advocates for the poor in Maine, who've spent much of the past year fighting the LePage adminstration over cuts to MaineCare, argue states in the study would have ended up spending even more money had they not extended coverage. Anna Hicks, a senior policy analyst at Equal Justice Partners, says the state will suffer financially, if it decides not to expand coverage under the new federal law.

"This expansion is really a deal for the state, an opportunity that we can't turn away from--the fact that newly-eligible folks in this program will receive 100 percent federal dollars in the first three years," she says.

Hicks says the Harvard study proves that the debate over medicaid expansion isn't just some wonky battle over competing spreadsheets. For many people, she says, it's a matter of survival.


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