Las Vegas Sun

November 25, 2015

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Health care:

Mortality rates lower in states with expanded Medicaid coverage for the poor

If Nevada had followed its neighboring state’s lead and expanded its Medicaid program a decade ago, it could have saved lives, a study published by the New England Journal of Medicine suggests.

Three states that expanded Medicaid — the state-run health insurance program for the poor — had lower mortality rates than neighboring states that chose not to, including Nevada, according to the study by the Harvard School of Public Health published last week.

The study compared Arizona, which expanded Medicaid coverage to adults without dependent children in 2001 and to parents of children earning up to 200 percent of federal poverty in 2002, to Nevada and New Mexico, which did not opt for expansion.

“State Medicaid expansions to cover low-income adults were significantly associated with reduced mortality as well as improved coverage, access to care and self-reported health,” according to the paper.

The study comes as Nevada Gov. Brian Sandoval is faced with a new decision on whether to expand Nevada’s traditionally meager Medicaid program under the Affordable Care Act.

A recent U.S. Supreme Court ruling on the health care law prohibited the federal government from compelling states to expand their Medicaid programs, giving governors and Legislatures the power to reject offering care to more lower-income people.

According to the Harvard study of previous Medicaid expansions, a state’s decision to cover more people reduced mortality by 6.1 percent.

Drops in the mortality rate were greatest among nonwhites and older adults.

The study estimated that 2,840 deaths per year were prevented for every 500,000 people who received additional Medicaid coverage. According to those statistics, Nevada could potentially prevent 700 deaths a year if it opts to expand Medicaid coverage to 140,000 currently uninsured Nevadans under the Affordable Care Act.

Benjamin Sommers, the lead author of the paper, warned it’s difficult to directly extrapolate numbers. But he said, “as a rough estimate,” the Las Vegas Sun’s calculation “is reasonable.”

In an email, Sommers said that the study’s findings should be considered by states like Nevada deciding whether to expand Medicaid.

“Our study suggests that expanding Medicaid enables people to access the care they need and their health improves, even to the point of potentially saving lives,” said Sommers. “While states have many factors to weigh in deciding whether to expand Medicaid, it should be clear from our study and others ... that this is a program that succeeds in its goal of helping improve health care and health for poor Americans.”

Sommers is currently working as an adviser with the U.S. Department of Health and Human Services. The article, however, was drafted while Sommers worked at the Harvard School of Public Health. Besides Arizona, the study looked at Maine, which expanded its program in 2002, and New York, which expanded Medicaid in 2001.

It is the first published study to look specifically at the effect of recent state Medicaid expansions on mortality among low-income adults, according to the authors.

Nevada has historically had strict eligibility requirements for the poor to get access to the state-run health insurance. Adults without dependent children generally cannot be covered unless they are disabled, and a family’s income has to be extremely low compared to other states.

Nevada’s Department of Health and Human Services, which administers Medicaid, did not dispute the findings of the study.

“It makes sense to us,” said Mike Willden, director of Nevada’s Department of Health and Human Services. “The more people who have improved access to health care, mortality rates are improved.”

The administration is still weighing whether to expand Medicaid. The potential cost to the state is a major factor in that decision.

“This is one in a mix of issues that we’ll be evaluating and talking about in the governor’s office,” Willden said.

Advocates for expanding the state’s health insurance system for the poor have for years warned that Nevada hurts poor residents by having tough requirements to qualify for Medicaid.

“We have to accept the fact that by not expanding Medicaid, people are going to die. Nevadans are going to die,” said former state Sen. Sheila Leslie, R-Reno.

She said even in flush years, there was little discussion of seriously expanding the state’s Medicaid system. Since 2008, when the state began slashing its budget, there has been virtually no such discussion in the Legislature.

Mike Hillerby, a former chief of staff to the late Gov. Kenny Guinn, said the administration did push to expand coverage to pregnant women and increase awareness of a separate state health insurance program for poor children.

But, he said, “sadly, it’s always been about the budget. We’ve always been pretty stingy with the programs.”

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