For years, researchers have documented the fact that uninsured people — who are predominately Americans living at or near the federal poverty line — face significantly increased risk for serious health problems over their lifetime. The Affordable Care Act takes the first step in addressing health disparities for poor Americans by expanding Medicaid coverage to all people with incomes up to 138 percent of the poverty line — $15,856 for individuals and $32,499 for a family of four in 2013. Nearly 17 million people are projected to gain coverage through the Medicaid expansion if all states participate.
But at least 13 states have indicated they will not expand Medicaid and several more are on the fence, posing a substantial threat to the ACA’s expansion of insurance coverage for the most economically vulnerable Americans.
The New England Journal of Medicine published a study late last year that demonstrates the life-saving potential of Medicaid coverage for low-income Americans. The study analyzed the effects of Medicaid expansion on adult morality in several states that had expanded coverage before the Affordable Care Act and found that Medicaid expansion was associated with a 6 percent reduction in mortality over five years for adults between the ages of 20 and 64. In other words, for many Americans, the difference between having access to Medicaid and not having access to Medicaid may literally be the difference between life and death:
The study adds to a growing body of research that demonstrates the (fairly intuitive) correlation between insurance, access to health care, and averted mortality. The Institute of Medicine, the Urban Institute, and other researchers and experts have documented either the potentially life-saving effect of Medicaid coverage or increased mortality rates among the poor and uninsured. While study design of the New England Journal piece cannot demonstrate with finality that Medicaid directly reduced the number of deaths in each state, it represents a methodologically rigorous assessment that rules out many of the other plausible explanations for the decreased death rate in states that expanded Medicaid coverage compared to those that did not expand coverage.
Medicaid protects the most vulnerable people in our society — children, pregnant women, seniors, and people with disabilities. Not surprisingly, the NEJM study found that mortality reductions were greatest among non-whites and residents of poorer counties. People of color represent 57 percent of the total Medicaid population and the majority of people that receive coverage through Medicaid are low-income women and children.
The American people are being presented with two very different visions for the future of our health care system: one in which the ACA is fully implemented and 17 million low-income Americans gain access to the health care they need and another, outlined in the GOP budget, which would repeal the ACA and decimate the Medicaid program converting it into a block grant.
The NEJM study reminds us what’s at stake in the current battle over Medicaid expansion: this fight is about ensuring basic human rights for American citizens.
Our guest blogger is Lindsay Rosenthal, a Research Assistant for Health Policy and Women’s Health and Rights at the Center for American Progress.