Fourteen states refuse to expand Medicaid to cover residents in households with incomes up to 138% of the federal poverty line. Research shows policymakers in those states are doing their constituents a disservice as a growing body of evidence points to both health and economic benefits related to Medicaid expansion.

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More than 14.7 million people gained coverage under Medicaid expansion since 2013 and this coverage  has been linked to greater access to care, more preventive care and improved chronic disease management, wrote researchers from Columbia and Harvard universities in a recent JAMA “Viewpoints” column.  

“The critical question posed by many policymakers is whether Medicaid expansion improves health,” wrote Heidi Allen, PhD, and Benjamin D. Sommers, MD, PhD. “Five years after implementation of the expansion an evidence base has begun to emerge.”  

Ensuring that Medicaid, the Children’s Health Insurance Program  and other safety-net programs are adequately funded is a major principle in the AMA’s vision on health care reform.  

The JAMA commentary is the latest to cite the growing evidence for how Medicaid expansion has improved care access and outcomes.

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“An increasing number of studies have provided rigorous evidence” of the positive impact Medicaid expansion has had on the health of low-income U.S. residents, the authors wrote. Two studies in particular are highlighted. 

In one of those studies, published in JAMA Cardiology, University of Pennsylvania researchers dug into county-level data on deaths from cardiovascular causes among residents 45–64 years old. They found that counties in expansion states had 4.3 fewer such deaths per 100,000 residents annually after Medicaid expansion than if they had followed the same trends in states that didn’t expand Medicaid coverage. 

They noted that “a stronger association” was observed between Medicaid expansion and cardiovascular mortality in counties with more low-income residents.

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The other study cited in the JAMA column, “Medicaid and Mortality: New Evidence from Linked Survey and Administrative Data,” was published in a National Bureau of Economic Research working paper this summer and it declares that “Medicaid expansions substantially reduced mortality rates among those who stood to benefit the most.” 

About 4,800 fewer deaths occurred annually in expansion states, adding up to 19,200 deaths averted between 2014 and 2017. By comparison, in states that didn’t expand Medicaid there were 15,600 additional deaths during the same period. 

“The estimated impact of the expansions increases over time, suggesting that prolonged exposure to Medicaid results in increasing health improvements,” the paper says. “By year four, residents of expansion states have annual mortality rate that is 0.208 percentage points lower than their non-expansion state counterparts.” 

“There is robust evidence that Medicaid increases the use of health care, including types of care that are well-established as effective such as prescription drugs and screening, and early detection of cancers that are responsive to treatment,” lead author Sarah Miller, PhD, assistant professor of business economics and public policy at the University of Michigan Ross School of Business, said in a news release. “Given this, it may seem obvious that Medicaid would improve objective measures of health.” 

This is a message the AMA has repeated for years while citing research that shows Medicaid expansion improves access to care, lowers the likelihood of patients delaying care because of concerns about costs, and makes good economic sense for uninsured workers, hospitals and state budgets.

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