Back in 2013- via a lot of hard work by public health advocates, solid support from many legislators, funding via an assessment on hospitals, and with the urging of Governor Brewer, Arizona restored Medicaid coverage to “childless adults” (who has previously been frozen out of the state’s Medicaid program) and extended coverage up to 138% of the federal poverty level. 

Those decisions have extended access to healthcare to hundreds of thousands of Arizonans (400,000 folks in the expansion population alone)- and have been a big reason why Arizona’s uninsured rate has dropped so precipitously.

A new study published this week (using national data) found that the states (like Arizona) that expanded Medicaid have saved lives in their states.  Likewise, the study found that the policy decision states made to not expand has led to premature deaths.  The new study compares mortality rates among 55- to 64-year-olds likely eligible for Medicaid in expansion states to mortality rates among similar older adults in non- expansion states.

The study found that Medicaid expansion from 100% of FPL to 138% saved the lives of at least 19,200 adults aged 55 to 64 from 2014 to 2017.  Conversely, 15,600 older adults died prematurely because of state decisions not to expand Medicaid.  Remarkably, there was an estimated 39 to 64% reduction in annual mortality rates for older adults gaining coverage. 

If all states had expanded Medicaid, the number of lives saved just among older adults in 2017 would roughly equal the number of lives that seatbelts saved among the full population.

Other studies have found similar results, so this week’s results aren’t surprising, since a large body of research has already documented mechanisms by which Medicaid expansion could be preventing premature deaths, and other studies have found reductions in mortality from pre-ACA coverage expansions. 

For example, other studies have found that Medicaid expansion resulted in:

  • Large increases in prescriptions filled for heart disease, diabetes, mental health conditions, and other chronic conditions.

  • Large increases in the share of low-income adults getting regular check-ups and other preventive care, and large decreases in the share without a personal physician or usual source of care.

  • Large decreases in the share of low-income adults skipping medications due to cost.

  • Decreases in the share of low-income adults screening positive for depression.

  • An increase in the share of people getting surgical care consistent with clinical guidelines, for example less invasive surgical techniques where feasible.

  • Increases in cancer screenings and early-stage cancer diagnoses.

  • A decrease in one-year mortality rates for patients diagnosed with end-stage renal disease.

How is Medicaid Funded?

Medicaid is financed by both the federal government and the states using a formula that is based on a state’s per capita income. The federal share (FMAP) varies by state from a floor of 50% to a high of 74% with exceptions for certain services or populations. The Affordable Care Act (ACA) expanded Medicaid eligibility for adults under age 65 and provided the states that chose to expand with an Enhanced FMAP of 100% federal funding through 2016 for the newly eligible adults. The federal share for the expansion population phased down to 95% in 2017 and to 90% by 2020 and beyond.

HERE is the Kaiser breakdown of Medicaid expansion spending by state.