Medicaid: Life & Death Politics?

By Carol GentryHealth News Florida

A Harvard study that found a longer life expectancy in states where Medicaid was expanded years ago could have significant implications for Florida, with thousands of lives each year riding on a decision that until now rested only on money and politics.

Gov. Rick Scott, a Republican who has been highly critical of the Affordable Care Act, calls Medicaid expansion a budget-buster. As soon as the Supreme Court deemed it optional, he ruled it out for Florida. But that was before the life-expectancy study came out.

Published a week ago in The New England Journal of Medicine, the article reported a significant drop in the death rate among the age 20-to-64 population in three Medicaid expansion states compared with a similar group in four neighboring states that didn’t expand. The implication: Many low-income adults who would have died before they made it to age 65 survived because of the access to care.

The difference in mortality rates, if applied to Florida, would yield about 5,680 fewer deaths per year among under-65 adults, Health News Florida calculated last week.

Incoming State Senate President Don Gaetz, in a brief phone interview, said he saw the description of the study in the The New York Times but didn’t get the impression that the expansion had been definitely determined as the cause of the improved life expectancy.

One of the study’s authors, Dr. Benjamin Sommers, had told the Times: “I can’t tell you for sure that this is a cause-and-effect relationship,” but added, “I can tell you we did everything we could to rule out alternative explanations.”

In his interview with Health News Florida, Sommers explained that researchers “very rarely use the word ’cause,'” because they must acknowledge that there is a slight possibility the result occurred by chance.

“The study does suggest that expanding Medicaid saves lives,” Sommers said. “To us, it looks pretty convincing.”

Sen. Gaetz said he wants to talk to the lead researcher “face to face” to get his questions answered. He didn’t say whether he wanted to hold hearings or talk privately.

Sommers said it would be appropriate to have one of his colleagues on the research team talk to Florida officials, since he is currently serving as a temporary advisor to the Department of Health and Human Services. The medical journal noted that Sommers completed the research project before going to HHS.

Sommers’ colleagues at the Department of Health Policy and Management at Harvard’s School of Public Health are the department chairman, Dr. Arnold Epstein, and health economics professor Katherine Baicker. She served as a health policy advisor to former President George W. Bush during his second term.

The Legislature will get a chance to weigh in since the Medicaid expansion isn’t scheduled until 2014. Leaders of both the House and Senate have said they want to withhold judgment until they can study the issue.

Both the House and Senate are under Republican control, a situation not expected to change in the fall elections, so advocates of Medicaid expansion have not had high hopes.

“The Harvard study makes it clear that the Legislature should expand Medicaid,” said Richard Polangin, a consumer health advocate in Tallahassee. “The benefits to society far outweigh the relatively modest increase in Medicaid’s budget. ”

Medicaid is a joint federal and state program for certain categories of low-income people: children, pregnant women, and elderly people who are too frail to manage without assistance. Almost no adults under 65 qualify unless they are physically or mentally disabled.

The federal government usually pays anywhere from 55 to 68 percent of the tab for Florida’s Medicaid program, which has grown because of the recession to account for about one-third of the state budget.

The Medicaid expansion would extend coverage to adults whose income is under 133 percent of poverty, which currently translates to about $30,000 for a family of four. In states that decide to enact the expansion, the federal government pays 100 percent until 2017, tapers to 90 percent by 2020, then stays at that rate.

The Kaiser Commission on Medicaid and the Uninsured has estimated that the Medicaid expansion would cover 1 million Floridians and bring $24 billion in federal funds to the state in the five years after it goes into effect.

But Scott and other governors have expressed concern that the state can’t afford its 10 percent and that the federal government may reduce its support over time.

There has been relatively little discussion of the possibility that Medicaid will improve public health. The Harvard study could change that.

The study focused on three states that expanded Medicaid around 10 years ago: New York, Maine and Arizona. Researchers followed the results for five years before and five years after the expansion, comparing them with four neighboring states that did not expand the program: Pennsylvania, Nevada, New Mexico and New Hampshire.

The research team reported that death-rate reductions were greatest among those in their 50s and early 60s, non-whites, and residents of poorer counties.

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