Health Insurance as a Public Health Intervention
In 2018, we wrote about Medicaid expansion under the Affordable Care Act and how it is benefiting people across the 36 states that voted for expansion. Our stance on the issue – that Medicaid expansion saves lives, including those affected by diabetes – has not changed, and recent new studies have come to light to further support this argument.
Earlier this month, the Commonwealth Fund published an article illustrating exactly how much health insurance coverage, particularly through Medicaid Expansion, saves lives. Specifically, it cited the National Bureau of Economic Research’s July 2019 study, which found that, between 2014 and 2017, 15,600 deaths in the US could have been avoided if all 50 states had expanded Medicaid. This sobering statistic is not the first of its kind: the Institute of Medicine (IOM) found that 18,000 Americans died in 2000 because they were uninsured, and the Urban Institute estimates that 137,000 Americans died between 2000 and 2006 due to lack of health insurance.
These disturbing results demonstrate an undeniable correlation between increased Medicaid coverage and prevention of deaths. In the Commonwealth Fund’s article, Dr. David Blumenthal and Ms. Shanoor Seervai use these studies to call for a reconceptualization of Medicaid expansion. Instead of framing it as a solely political issue, he suggests that “policymakers exploring different options for health reform can legitimately view insurance as a public health program like vaccination or blood pressure control — that saves thousands of lives.”
In most political discussions – such as in the current Presidential debates – Medicaid expansion has often been viewed as a liberal versus conservative issue involving insurance and tax payers. For example, a highly-criticized study by the Wisconsin Institute for Law and Liberty, a conservative group, focused on its conclusion that Medicaid expansion would increase the consumer costs of private insurance (a questionable conclusion as is). Beyond receiving objections from Democrats for faulty methodological and analytical calculations, the study also alarmingly omitted evidence of better health outcomes in Medicaid expansion states. Human life should be considered as the most important policy factor, not as a side note or an omission, and treating Medicaid expansion as a public health program is how we can focus on what really matters.
For a refresher on what Medicaid expansion is, please see the bottom of this article.
Is Medicaid expansion as a public health intervention a new idea?
Not really. There have already been several examples of Medicaid expansion functioning as a public health initiative. In a study from 2015, the American Diabetes Association (ADA) found that in Medicaid expansion states, the number of Medicaid recipients newly identified with diabetes increased by 13% after Medicaid was expanded, versus a 0.4% increase in non-Medicaid expansion states during the same period. This increased number of diagnoses allows for earlier treatment for individuals and fewer complications and deaths later in life. Accordingly, these findings from the ADA suggest the possibility of better long-term outcomes for people with diabetes. Given that Medicaid recipients are also disproportionately affected by diabetes, Medicaid expansion is a promising way to expand coverage and treatment to people with diabetes in underserved populations.
In parallel, adults on Medicaid are also disproportionately affected by opioid addiction and in need of access to treatment. Fortunately, in a New York Times article from August 2019, researchers found that states that expanded Medicaid have much larger increases in prescription rates for buprenorphine, an anti-craving drug that treats opioid addiction. Lisa Clemens-Cope, the study’s lead author, says that “expanding Medicaid is probably the most important thing states can do to increase treatment rates.” Both the diabetes epidemic and opioid crisis are examples that show Medicaid expansion extends beyond a political talking point and becomes a tool for saving thousands of lives.
Just as how mass plagues and deaths are avoided with adequate vaccination policies, thousands of deaths – both related to diabetes and not – can be avoided with proper health coverage across every state in the US. We hope policymakers will use the results of these studies to make informed policy decisions about increasing access to health insurance.
A refresher on Medicaid expansion
Since January 1, 2014, the Affordable Care Act’s Medicaid expansion has provided millions of Americans with health insurance. Currently in effect in 36 states and Washington DC, the Medicaid program provides coverage to individuals at up to 138% of the federal poverty level ($17,236 for an individual in 2019). However, in the 14 states without expansion – Alabama, Florida, Georgia, Kansas, Mississippi, Missouri, North Carolina, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Wisconsin, and Wyoming – many people remain uninsured because their income is above the state’s qualifications for current Medicaid eligibility but below the lower limit to purchase private health insurance. In fact, over two million uninsured adults fall into this “coverage gap” in states that have decided not to expand Medicaid.
By Karena Yan