Did Supreme Court Chief Justice John Roberts kill almost 16,000 people? That is one way, if a hyperbolic one, to read a new study on federalism and Medicaid. Economists looked at the long aftermath of the Court’s 2012 decision to allow states to opt out of the Affordable Care Act’s Medicaid expansion. They found that opt-in states experienced a 9.3 percent reduction in the mortality rate among near-elderly adults of lower socioeconomic status, adding up to thousands of lives saved. Opt-out states, accordingly, experienced thousands of avoidable deaths.
The study, conducted by government and academic researchers using large pools of health, income, and mortality data, demonstrates something reassuring and something discomfiting, particularly in light of Republicans’ ongoing efforts to repeal, alter, sabotage, or roll back the Affordable Care Act: Medicaid saves lives, and the country’s ongoing insurance crisis takes them needlessly away.
That first point continues to be a contentious one. Pathbreaking research on a Medicaid lottery held in the state of Oregon a decade ago found that people who got insurance felt far better, with coverage reducing both emotional and financial distress. But it had no effect on the physical-health measures examined during the study period, such as blood-pressure readings. People’s heads and wallets got better, but their hearts and lungs did not, the study indicated, nor did there seem to be any effect on the mortality rate.