Failure to Expand Medicaid: Just Another Death Penalty?

For many, the fight over whether or not to expand Medicaid is just about the money.  But they overlook the fact that the lives of more than 36,000 people may hang in the balance. 

That’s the conclusion that can be drawn from a study published last summer in the New England Journal of Medicine.  The study was entitled Mortality and Access to Care Among Adults After State Medicaid Expansions.  In it, the authors calculated the numbers of lives saved as a result of an earlier Medicaid expansion in three states.

The three states were Arizona, New York, and Maine.  And while none of these expansion populations matched exactly the expansion population in the Affordable Care Act, they were similar enough to suggest that we might see the same results in the ACA Medicaid expansion population.

The authors concluded that Medicaid expansions could save 19.6 lives for every 100,000 people between the ages of 20 and 64. 

There are over 185 million Americans between the ages of 20 and 64.  That comes to 36,301 lives saved.

These lives are more important than the money. 

These people have families and friends who care about them.  And while some would like to think they should be able to make it on their own, the truth is that they need our help.

Most elected officials seem to get this.  I don’t see why it should even be newsworthy that six Republican governors have now said they support the expansion.   They understand reality.

For example, Governor Jan Brewer of Arizona favors the ACA expansion.  Expansion will save her state money, and it could also save an estimated 723 lives.  For a pro-life governor, what’s not to like about that?

Arizona was the last state to embrace the original Medicaid program.  Perhaps the people of Arizona learned from that experience something that the rest of us take for granted – Medicaid makes a big difference in the lives of people in the state as a whole.

In the four most populous states alone, the numbers of lives hanging in the balance is in the thousands. 

California and New York are already moving forward with the expansion.  That’s good news for an estimated 6700 people, 4421 in California and 2325 in New York.  One of those California lives saved could be my son’s.

But in Texas and Florida, two states at the epicenter of the anti-expansion universe, over 5000 lives still hang in the balance – 2925 in Texas and 2162 in Florida.  The decisions of those state legislatures will have a profound effect on the lives of many other fathers’ and mothers’ sons and daughters.

But expansion means lives saved in every state.  North Carolina can save 1126, Connecticut 422, and Utah 304. 

The table I’ve created with the calculations for all the states is here.

Every study has its limitations, and this one is no exception. 

However, the authors openly acknowledged the limitations of their study when they published it.  They noted that other analyses of the data led to similar results.  By one alternate analysis, they found that for every 176 new adults covered by Medicaid, one death was prevented.

That doesn’t seem like many at first.  However, the ACA Medicaid expansion, if fully implemented by every state, will cover an estimated 15.1 million new adults.  By that measure the expansion would save even more lives – a total of 85,568 nationwide.

What about the money?

In March of last year, the Congressional Budget Office calculated the cost of a full Medicaid and SCHIP expansion to be roughly $103 billion per year.  (More recent CBO Medicaid cost estimates are lower because CBO assumes not all states will expand.)  That comes to $2.8 million per life saved. 

The state share of that cost would be about $198,000.

I’m sure that some might argue that we can’t afford $2.8 million per life – unless of course, the life is their own or their child’s.

But more objective researchers with no political agenda to promote have actually taken the time to calculate the economic value of a life.  It comes to $7 million or more, making the paltry $198,000 one of the best investments a state could make.

So the questions become first, how much are our lives worth to our states?  And second, is the failure to expand Medicaid just another death penalty – one that targets the sick and innocent?

To reach Paul Gionfriddo via email: gionfriddopaul@gmail.com.  Twitter: @pgionfriddo.  Facebook: www.facebook.com/paul.gionfriddo.  LinkedIn:  www.linkedin.com/in/paulgionfriddo/