For journalists covering the Build Back Better legislation and those in the 12 states that have yet to expand eligibility for Medicaid enrollment, new research shows that doing so could save lives.

An estimated 2.2 million people would benefit from Medicaid expansion in the 12 nonexpansion states: Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin and Wyoming, according to research from the Kaiser Family Foundation. As the nation’s largest health insurer, Medicaid provides health insurance to almost 75.8 million Americans.

Not only does this latest research renew the argument for expansion, but it could also help supporters of President Biden’s Build Back Better bill gain passage of the legislation in the U.S. Senate. The U.S. House of Representatives passed the bill on Nov. 19, as Emily Cochrane and Jonathan Weisman reported for The New York Times.

At US News and HealthDay, Robert Preidt reported on the study from researchers at the Keck School of Medicine at the University of Southern California. Medicaid expansion was associated with nearly 12 fewer deaths per 100,000 U.S. adults annually, and expansion could lead to a decline in adult deaths each year of 3.8%, Preidt explained. Also, Medicaid expansion-related declines in deaths varied by state and by disease, he added.

Lancet Public Health published the study Dec. 2, “Medicaid expansion and variability in mortality in the USA: a national, observational cohort study.”

The research has not received much coverage yet, which could be because previous studies have shown reductions in mortality after Medicaid expansion. Tara Golshan at Vox reported on one of those studies in 2019. But the research in Lancet is significant for journalists for two reasons.

• First, previous studies on the benefits of Medicaid expansion have shown improvements in health outcomes but none of the earlier research has provided in-depth analyses of the variability in mortality at the state-level, noted researchers Brian P. Lee, M.D., Jennifer L. Dodge, M.P.H., and Norah A. Terrault, M.D.
• Second, the benefits of expansion take time because most adult deaths are linked to chronic, long-term medical conditions, they added. Therefore, the potential benefits of Medicaid expansion might not have been apparent in the previous studies.

“For example, the lag time to benefit of statins to reduce cardiac events is 2.5 years, and of breast and colorectal cancer screening to reduce neoplasia-related mortality are 3.0 years and 4.8 years, respectively,” the researchers wrote.

In an email comment to AHCJ, Lee said, “The characteristics of the states that had the most significant reductions in deaths from Medicaid expansion (more Black people, greatest conversion from uninsured to insured) would suggest that states that have yet to expand may benefit the most from Medicaid expansion because nonexpansion states have even higher proportions of Black people and uninsured adults than expansion states.”

Under the Affordable Care Act, all states and the District of Columbia could increase eligibility for Medicaid enrollment starting January 1, 2014, when the law became effective. The U.S. Supreme Court allowed states to decline to expand enrollment, and, to date, only 38 states and the District of Columbia have adopted and implemented expansion plans, according to an analysis from Kaiser Family Foundation.

For the Lancet study, the researchers collected data on all reported deaths in the United States among adults ages 25 to 64 years from January 1, 2010, to Dec. 31, 2018. Then, they compared the death rates in the first four years (2010 through 2014) with death rates in the next four years. Through 2018, approximately 32 states had expanded Medicaid and 17 had not, according to data from the foundation.

Four compelling angles for journalists to consider

1. One of the most important findings is that raising the number of people who have health insurance helps to drive down mortality rates, according to an article that Keck published about the research. This finding is important because the Build Back Better bill would allow residents of the 12 states that have not expanded Medicaid to purchase subsidized coverage on the ACA marketplaces in 2022 through 2025, according to an analysis from the foundation. The federal government would fully subsidize the premium for a benchmark plan and provide subsidies to reduce out-of-pocket costs to 1% of overall covered health expenses on average, the Kaiser Family Foundation noted.
2. Medicaid expansion is a health equity issue. “States that have chosen not to expand Medicare have higher proportions of poor and Black residents, so they may have the most to gain from adopting Medicaid expansion,” Lee said.
3. Medicaid expansion led to fewer cardiovascular and respiratory deaths, the researchers noted, explaining that more access to specialty care and prescription drugs likely results in fewer deaths from chronic conditions.
4. The research shows that expanding Medicaid did not affect deaths related to cancer, infections or opioids in part because the preventive care available to those with health insurance may not have a significant influence on these conditions.