HLTH 349 Week 6 Article Review 3 Example

Does Health Insurance Save Lives? A Review of Linked-Data Evidence on Medicaid Expansion and Mortality

Introduction

Whether health insurance saves lives seems obvious to most people, yet it has been surprisingly hard to prove, because people with and without coverage differ in many ways. Miller et al. (2021) addressed the question using the natural experiment created when some states expanded Medicaid under the Affordable Care Act in 2014 and others did not.

Summary

The authors linked responses to a large federal survey with official death records, which allowed them to identify adults most likely to gain Medicaid, those aged 55 to 64 with low incomes, and to follow whether they died in later years. They compared changes in mortality in expansion states with changes in nonexpansion states. Before 2014, death rates in the two groups of states followed similar trends. Beginning in the first year of expansion, deaths fell more in expansion states, and the authors confirmed the pattern with placebo tests and alternative definitions of the sample: each year's death rate dropped 0.132 percentage points, which equals 9.4% of the average rate. The effect came from fewer deaths due to disease and grew larger over time.

Discussion

McKenzie et al. (2018) explain that insurance shapes access to the health care system: people without coverage delay care, skip medications and are less likely to have chronic conditions detected and treated. The study suggests those access differences translate into deaths among adults nearing Medicare age, a group with high rates of heart disease, diabetes and cancer. The finding is consistent with earlier evidence. Sommers et al. (2012) studied three states that expanded Medicaid before 2014 and found a 6.1% relative reduction in deaths among adults aged 20 to 64, with the largest reductions among older adults, nonwhite residents and people in poorer counties. When two studies using different expansions and different methods both find fewer deaths, the case that coverage saves lives becomes difficult to dismiss. The study's strength is its linked data, which avoid the guesswork of county averages. Its main limitation is its focus on near-elderly adults, so the effect on younger adults may be smaller, since they die less often from the chronic diseases that coverage helps control. The study also cannot show which services made the difference, whether medications, cancer screening or simply having a regular doctor, which leaves an important question for future research.

Conclusion

This article provides strong evidence that Medicaid expansion reduced deaths, with benefits that grow over time. It also shows the value of linking survey and death records, a method public health researchers can use to evaluate other policies. For the states that have not expanded Medicaid, it raises a serious public health question about lives that coverage might save, especially among older low-income adults who are not yet eligible for Medicare.

References

McKenzie, J. F., Pinger, R. R., & Seabert, D. M. (2018). An introduction to community & public health (9th ed.). Jones & Bartlett Learning.

Miller, S., Johnson, N., & Wherry, L. R. (2021). Medicaid and mortality: New evidence from linked survey and administrative data. The Quarterly Journal of Economics, 136(3), 1783-1829. https://doi.org/10.1093/qje/qjab004

Sommers, B. D., Baicker, K., & Epstein, A. M. (2012). Mortality and access to care among adults after state Medicaid expansions. New England Journal of Medicine, 367(11), 1025-1034. https://doi.org/10.1056/NEJMsa1202099