Research shows a strong connection between mortality rates and insurance status: The uninsured are more likely to have poor health and higher mortality rates than those with insurance. People without insurance are less likely to receive preventive services and more likely to delay or go without necessary doctors’ visits, prescription medicines, and other treatments that reduce unnecessary morbidity and premature death. As a result, this group has poorer health outcomes, a lower quality of life, and more premature deaths. The uninsured are also at greater risk of death following a trauma, heart attack, or stroke.
A study—“Mortality and Access to Care among Adults after State Medicaid Expansions”—published in the New England Journal of Medicine last year analyzed the effects of Medicaid expansion on adult mortality in several states and found a connection between access to Medicaid and reduced mortality. This study underscores the importance of the current debate that is taking place in many states about whether to expand Medicaid as part of the Affordable Care Act.
To ensure that those who most need health coverage can access care, the Affordable Care Act expanded the federal minimum Medicaid eligibility level 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.* But the Supreme Court decision that upheld the health care law also allows states to opt out of the expansion without losing their existing federal Medicaid funds. This means that, unfortunately, Medicaid coverage is not yet guaranteed for many Americans in this group. Nearly 17 million Americans would gain coverage through the Medicaid expansion if all states participated in the expansion, which could improve the health status of millions of Americans and reduce mortality rates.
The graphic below estimates the number of deaths that could be averted in some of the states that continue to oppose Medicaid expansion. This is not an exhaustive list of states—we only included states that currently have low thresholds for Medicaid eligibility for nondisabled adults so that our estimates would be conservative and would not overstate the potential impact of expansion on averted mortality in a given state.
The researchers of the New England Journal of Medicine study compared mortality levels in several states that implemented a Medicaid expansion to demographically and economically similar states that did not implement a Medicaid expansion in order to determine the effects of the expansion on adult mortality over a period of five years. Since the study was limited to only a few states, there may be some variation across estimates depending on how Medicaid expansion is implemented in each state.
Based on the results of the study, we applied the ratio of 2,840 averted deaths within a state population of 14.5 million people to the population of adults between the ages of 19 and 64 in every state to estimate how many lives could be saved through Medicaid expansion. The proportion is based on the average averted mortality rate of states in the original study. The actual estimates for averted deaths for each state will vary depending on the baseline numbers of uninsured and enrollment rates after Medicaid expansion is implemented. State population data is taken from the Kaiser State Health Facts and represents a two-year average of state populations between the ages of 19 and 64 in every state.
In these states alone more than 12,000 lives per year could potentially be saved if state governments agree to expand their Medicaid programs. Let us not lose sight of what is really at stake in the battle over Medicaid.
Maura Calsyn is the Associate Director of the Health Policy team at the Center for American Progress. Lindsay Rosenthal is a Research Assistant on the Health Policy and the Women’s Health and Rights teams at the Center.
* The Affordable Care Act includes a special adjustment to income that effectively raises the eligibility level by 5 percentage points to 138 percent of the poverty level.
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