Mortality and Access to Care among Adults after State Medicaid Expansions, Benjamin D. Sommers, M.D., Ph.D., Katherine Baicker, Ph.D., and Arnold M. Epstein, M.D. New England Journal of Medicine, July 25, 2012
“Our study documents that large expansions of Medicaid eligibility in three states were associated with a significant decrease in mortality during a 5-year follow-up period, as compared with neighboring states without Medicaid expansions. Mortality reductions were greatest among adults between the ages of 35 and 64 years, minorities, and residents of poor counties. These findings may influence states’ decisions with respect to Medicaid expansion under the Affordable Care Act. Our study shows a mortality reduction associated with state Medicaid expansions to cover adults. Using state-level differences in Medicaid expansion as a natural experiment avoids the confounding between insurance and individual characteristics (e.g., poverty or health status) that plagues cross-sectional observational studies. These results build on previous findings that Medicaid coverage reduces mortality among infants and children and are consistent with preliminary results of a randomized, controlled trial of Medicaid in Oregon, which showed significant improvement in self-reported health during the first year (although objective measures of health are not yet available and 1-year mortality effects were not significant and were imprecisely estimated).”
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