While congress is debating about cutting Medicaid, a large study shows that it saves lives

The expansion of Medicaid has saved more than 27,000 lives since 2010, according to the most definitive study so far on the health effects of the program.

Poor adults who have received medicoid coverage after the affordable care act had expanded access, 21 percent less likely to die during a certain year than those who are not registered, the study shows. By analyzing the federal data on 37 million Americans, two economists discovered that the dead not only fell at older registrations, but also among those in the twenty and 30 – a group often assumed that they often had few medical needs, and who would have been far Less chance to be eligible for Medicaid before the expansion.

The findings were published this month in a National Bureau of Economic Research labor paperWhile house republicans were drawing up a plan that could significantly reduce Medicaid, which covers 71 million Americans with a low income or disabled people. The House Energy and Commerce Committee, which supervises the program, has been approved, A series of policy measures on Wednesday that the estimated congress budget agency millions of people To lose their coverage in the coming years.

The authors of the study said that the timing of the publication was by chance – their research has been going on for two years – but acknowledged that the findings were mainly relevant to the current budget discussions.

The researchers discovered that it costs on average Medicaid $ 179,000 to save a year of life – comparable to the amounts spent on health care interventions such as screening of cervical cancer and treatment with leukemia. It is less than the combined public and private expenses for interventions such as safety inspections for cars or removing asbestos from buildings.

Earlier research showing that Medicaid can save lives, was carried out on a much smaller scale and usually reflected data about older, sicker populations. The new study included linking tax, death and medicaid registration records to collect data about almost every poor person in America, so that the researchers can measure the effects of Medicaid with much greater precision and security.

Health economists that are not involved in the study described the work as the most convincing evidence so far that Medicaid – and health insurance in general – saves lives.

“It is an important scientific contribution that helps us to think about the size of what Medicaid does,” said Amy Finkelstein, a health economist at the Massachusetts Institute of Technology that was not involved in the research.

Sarah Miller, an economist from the University of Michigan who studied the health effects of Medicaid, said that she was mainly affected by the new findings about younger registered persons who were good for 29 percent of the 27,400 lives saved.

“The benefits are much widespread than we originally thought,” said Dr. Miller. “From a cost-benefit point of view, there is much more advantage of saving someone who is 25 than 61, not because their lives are of less value, but because there are many more years of life to live.” In the study, people in the twenty and 30 years accounted for almost half of the years of life.

Although the relationship between health and health insurance seems simple – access to medical care should lead to better health results – few rigorous studies have been able to find such a connection.

A 15-year-old study Because of the Rand Corporation, in the early 1970s, I looked at what happened when private individuals insured patients had to pay more for the use of medical care, in the form of higher CO payments or deductible. At the end of the study, the researchers found few health differences between patients who had to deal with higher costs and those who had not done that.

Dr. Finkelstein and other researchers looked at the Natural experiment That happened when Oregon held a lottery in 2008 for Medicaid registration (the state could not afford to cover everyone who wanted it). Research shown Some improvements in mental health care after two years in people who had gained medicaid, but not a statistically significant change in physical results.

Both studies include relatively small groups of people, making it difficult to measure differences in rare medical events or deaths.

Joseph Newhouse, professor in health policy at Harvard, who led the Rand experiment, said he was enthusiastic about the new findings. His sample size was too small to effectively measure meaningful health differences, he said. And, he noticed, because of medical progress in the decades since his studies, the insurance coverage can now be more valuable than then.

“We have things that now work for a number of cancers, and we have statins,” he said, referring to cholesterol -lowering medicines that have been shown to reduce the risk of heart attacks. “In other words, medical care is probably more effective in reducing mortality than in the 1970s.”

For decades, poor Americans have been the demography that probably has health insurance. Low wages rarely offer affordable coverage, and for the majority of the history of Medicaid it did not cover an adult with a low income unless they were pregnant or disabled, or had young children. But that started to change in 2014, when Obamacare States offered generous federal financing to expand the coverage. Since then, a flurry of investigation has made a connection between Medicaid coverage and death.

Although Early studies Discovered that death rates fell in states that participated in the Medicaid extension, they could not demonstrate any cause and effect. More recent research found A decrease in the dead Among older or sicker adults who had gained medicaid, but it did not investigate health benefits for younger registered people.

Another study, which compare uninsured Americans with people who have purchased cover at the market places for Affordable Care Act after he has been randomly selected to receive a reminder letter, also found That those who bought insurance were less inclined to die.

A falling death rate is often used as a proxy for measuring large health improvements in general. But studying mortality rates usually requires an extremely large data set.

“Death is a rare result and, like so many rare results, you need a lot of data to study it,” said Angela Wyse, a health economist at the Dartmouth College and co-author of the new study with Bruce D. Meyer, an economist at the University of Chicago.

This study did not identify specific treatments that had saved lives – for example preventive medicines or access to mental health care. The most important causes of death in younger adults are overdose of drugs and suicide, but some die from conditions that occur more often in the elderly, such as cancer or heart disease.

The study also noticed the limitations of Medicaid. In the United States, as in most developed countries, the death rates are higher among poor people Then rich. Covering all poor people with Medicaid would reduce that inequality by only about 5 to 20 percent. Other factors, such as exposure to violence or pollutants, can influence the life span more than access to medical care.

“Everyone gives Medicaid would be useful, but there would still be a huge gap,” said Dr. Wyse. “There is so much more going on than the health insurance.”

Extra work of Asmaa Elkeurti.