Thousands of People Die Annually Because States Refuse to Expand Medicaid


We already knew that Medicaid expansion saves lives. Now, a new National Bureau of Economic Research working paper published today found that the decision of 14 states not to expand Medicaid under the Affordable Care Act cost approximately 15,000 lives.

The Affordable Care Act would have expanded Medicaid in all states, allowing anyone making up to 138 percent of the federal poverty line to use the program. In 2012, however, the Supreme Court decided that the states must be allowed to decide whether to expand Medicaid, and as of now, 14 states still haven’t expanded it for various stupid reasons. In most of those states, childless adults without disabilities aren’t eligible for Medicaid regardless of how low their income is, not to mention the onerous new work requirements some states that did expand Medicaid are testing out.

The paper, led by economist Sarah Miller at the University of Michigan, examined death rates in populations who would have benefitted from Medicaid expansion—i.e., those with incomes between 100 percent and 138 percent of the federal poverty line, excluding non-citizens who are ineligible for Medicaid—using mortality figures and data from the American Community Survey. The study revealed an “average decrease in annual mortality of 0.13 percentage points during the four-year post period” in states that did expand Medicaid, translating to “approximately 4,800 fewer deaths” per year, “or roughly 19,200 fewer deaths over the first four years alone” in their sample.

The flip-side of this: In states that didn’t expand Medicaid, the authors say, that decision “likely resulted in 15,600 additional deaths over this four year period that could have been avoided if the states had opted to expand coverage.” These figures are based on a sample population of roughly three million in the non-expansion states.

These numbers are stark, but it shouldn’t be news to anyone that having health insurance can make the difference between life and death. It’s the difference between getting a troubling cough checked out, or going to the hospital when you already can’t breathe. It’s the difference between accessing medicines you need to live, and dying.

The more people who remain uninsured—which would remain a feature of American life under certain Democratic presidential candidates’ healthcare plans—the more unnecessary deaths that will occur. And the more people have unusable health insurance with deductibles in the thousands of dollars, the more people will die because they could not afford to get care until it was too late. It is pure madness that we haven’t already fixed this, and it needs to end.

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