Study: Az death rates shrank when Medicaid coverage grew

Arizona’s 2001 expansion of Medicaid coverage resulted in lower death rates in the state, according to a study of several states that links increased coverage to fewer deaths and overall better health.

The study, published Wednesday in the New England Journal of Medicine, looked at three states that expanded their Medicaid programs in 2001 and 2002 to cover childless adults. By looking at states with that “major Medicaid expansion,” the study hoped to predict what the future of Medicaid expansion under the Affordable Care Act might hold.

In the five years after Arizona, New York and Maine expanded Medicaid to cover childless adults, those states posted an average 6.1 percent decrease in mortality rates compared to neighboring states, the study said.

“The ultimate goal of medical care is to keep people from dying prematurely,” said Dr. Benjamin Sommers, a Harvard professor and one of the authors of the study. “So we focused on mortality but also looked at other factors along the way.”

The report comes as Arizona, like other states, is deciding whether to take part the Medicaid expansion called for in the Affordable Care Act. While he welcomed the report’s findings, one state official involved in the deliberations said the study will have little bearing on Arizona’s decision to expand.

Arizona Health Insurance Exchange Director Don Hughes said it’s no surprise that people with health insurance – whether that is Medicaid or private insurance – receive better health care.

“It makes the case that people who get covered have better outcomes and live longer,” Hughes said. “But does that mean that putting people only into Medicaid will have better health outcomes? No.”

But health advocates argue that the findings cannot be ignored.

“Increased coverage under the (federal health reform act) expansion would most likely decrease mortality rates even further,” said Matt Jewett, director of health policy at Children’s Action Alliance in Arizona.

The study was done before the Supreme Court’s June ruling that Medicaid expansion was a state option under the Affordable Care Act. Under the federally funded Medicaid expansion, childless adults who earn up to 133 percent of the federal poverty line would be covered in states that participate.

“The national question was, what happens when you expand Medicaid coverage to this group?” Sommers said. “And so we looked at the three states that have kind of already started to it to give a sense of what would happen in 2014.”

Beginning in 2001, Arizona’s Medicaid program – the Arizona Health Care Cost Containment System – covered childless adults who earned the federal poverty level or less. But an enrollment freeze that took effect last year has since trimmed the number of people getting that coverage.

Arizona’s Medicaid program is still “one of the most effective and of the highest quality in the country,” Jewett said. And Arizona is one of the only states to cover childless adults at all. But Arizona’s coverage has decreased significantly since 2007, when data used in the study was collected.

Jewett said that for childless adults, Arizona was one of “only a handful of states fully cover them up to the federal poverty level.”

Hughes said Arizona’s decision on Medicaid expansion likely will not come until November.

“There are still many unanswered questions regarding Medicaid expansion for the state,” he said.