Death Rates Vary in Medicaid Study - Wall Street Journal

By JENNIFER CORBETT DOOREN

States that opted for larger Medicaid programs had lower death rates, according to a study released Wednesday in the New England Journal of Medicine.

The findings come as states struggle with the growing financial burden of the health-insurance program for the poor, and weigh whether to take part in its expansion under President Barack Obama's health-care law.

Last month, the Supreme Court upheld most of the law, but said the government can't punish states that decline to expand their Medicaid programs in 2014. The law called for expansion as a way of covering more uninsured low-income adults.

Medicaid, a federal-state program, has traditionally covered low-income mothers and children as well as disabled adults but was expanded by some states a decade ago to cover some nondisabled adults without children.

Prior research suggested a decline in mortality among children that was associated with Medicaid expansions in the 1980s, but until now there hasn't been similar information on adults.

The new study, by researchers at the Harvard School of Public Health, was primarily designed to look at the impact on death rates in three states that expanded Medicaidâ€"Maine, New York and Arizonaâ€"compared with four nearby states that didn't. Overall, the study found a drop in mortality of 6.1% on average in the five years after initial expansion. Death rates fell by 19.6 deaths per 100,000 adults compared with the control states of New Hampshire, Pennsylvania, Nevada and New Mexico.

The study's lead author was Benjamin Sommers, an assistant professor of health policy and economics at the Harvard School of Public Health. Dr. Sommers is working as a temporary adviser in the Department of Health and Human Services and will return to Harvard on Sept. 1. The New England Journal said the article was conceived and drafted while Dr. Sommers was at Harvard.

Mortality declines were greatest among older adults, nonwhites and residents of poorer counties, according to the study.

The study's authors said the research, which received no external funding, doesn't prove Medicaid was the reason for the declines, but wrote: "The fact that mortality changes were largest in expected subpopulations offers some reassurance that we have isolated the effect of Medicaid expansion."

Scott Gottlieb, a physician and resident fellow at the conservative-leaning American Enterprise Institute, a research group, said while the study suggests Medicaid is better than being uninsured, it "doesn't change the fact that Medicaid has been poorly funded, poorly administered and often relegates the poor to bad-quality medical care."

Write to Jennifer Corbett Dooren at jennifer.corbett-dooren@dowjones.com