Data hint that bolstering the system benefits even those already enrolled.

One of the provisions of the Affordable Care Act, scheduled to take effect in 2014, will allow states to expand Medicaid to include all adults with incomes near the federal poverty level. Researchers tried to predict health benefits from this measure by examining outcomes in three states that have enacted similar Medicaid expansions already.

Adjusted all-cause mortality in the Medicaid-expansion states (New York, Arizona, and Maine) declined by 6.1% in the 5 years after expansion, which is a significant difference compared with mortality in adjacent states used as controls (Pennsylvania, Nevada, New Mexico, and New Hampshire). The differences were greatest among nonwhites, residents of poor counties, and 35- to 64-year-olds. A smaller (but also significant) mortality difference (2.6%) was observed in adults older than 65, along with a significant decline in cost-related delays in care.

Comment: This “natural experiment” addresses a long-debated statistic in the health policy world, in which Medicaid coverage has been associated with worse rather than better health outcomes among adults. This study shows that when confounders are removed, the association is more likely inverse. Although this study had a variety of statistical caveats to consider, its results are consistent with both mortality benefits of Medicaid already established for infants and children, and preliminary results of a randomized, controlled trial of Medicaid expansion in Oregon.

Source: Journal Watch General Medicine