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January 28, 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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  1. "Drops in the mortality rate were greatest among non-whites and older adults". Sounds like the same demographic the GOP is going after to disenfranchise their Constitutional right to vote, in states like Florida and Pennsylvania. Sandoval has no shot at VP this cycle or any cycle. Let's help the citizens of your state Mr. Sandoval.

  2. For Republicans wishing to deny Health Care to the Poor Working Class (Most Service Sector Jobs)and all others in Poverty, This is now a Moral Issue. It's interesting How Many Republican "Christians" never see their Biblical Mission as helping the Poor.

  3. Romney: US has 'moral imperative' to aid Israel in its defense against a nuclear Iran.

    The moral imperative for icons of American religion is borrowing money to build up the military and financing their churches. The rank and file take instructions from their leaders.

  4. This should be a no brainer. Especially with a total of TWENTY-THREE PERCENT of the population of Nevada enjoying little or no health care coverage.

    But our Governor drags his feet. Coming up with lame excuses that only make sense to a small percent of the ultra-conservatives here in Nevada.

    All while this indecision goes on, Governor Sandoval is now confirmed to be fully in charge of a duly elected government for a State that now has been proven they could care less for the safety, health and welfare of its citizens.

    Sarah Palin was wrong. The Affordable Care Act and the death camps she foresaw happening didn't happen. However, these death camps did happen, but not how she anticipated.

    Governor Sandoval is now on record as the camp commandant for the death camp that encompasses the entire Sovereign State of Nevada.

    The more he waffles, the more people die. More blood spilled will be on his hands. Blood that will not be washed off, nor attributed to anyone else's doings. No amount of right wing propaganda is going to ever change the minds of even the least informed voters out here in Nevada who is responsible.

    Start worrying about your people, Governor Sandoval. And not your political ambitions.

  5. <<But, then, democrats, liberals, might lose a few they've enslaved to dependence>>

    Think you have this wrong. You don't understand the Medicaid system. Some people have no choice but to be on Medicaid.

  6. So by not expanding Medicaid the Governor HIMSELF is a DEATH PANEL of 1!

  7. Ya well mortality rates are a lot lower in states with far fewer illegal immigrants and their contagious diseases and crime activities. Mortality rates are also a lot lower in areas where there are severe food shortages of long duration--just short of starvation diets.

  8. Would someone ask Miss Leslie how we can afford everything? $12K a year for K-12 for thousands of illegal immigrants. Law enforcement and courts for same. Long-term unemployment concerns due to 14 million illegals in NON-AGRICULTURAL jobs. Section 8 free housing vouchers to use at any apartment complex for all the anchor babies and families. Vaccines, school supplies, free breakfast and lunch, free bags of groceries sent home.....

  9. Sick: Ya, sure, you betcha--I'm not a Palin devotee, not hardly, grew up where they say that kind of thing (not Alaska). I'm not sure we agree much but we do agree on some things. My overall frame of reference includes that it's tough when you get older AND NO ONE EXPECTS IT. There is little publicity and little info available. I used to wonder and ask why there were so few to no older employees when I worked here and there. No one gave a good answer. Eventually I figured it out--they dumped employees, other than close personal friends of the big boys, when employees were topped out in salary. Must have thought they could get good work out of the newbies despite limited knowledge of how things are done. Anyhow, Mr. Sick, I see you are at least as direct and succinct as I am. I see you can do the math. If I don't reply to a specific question, you can try clicking on my handle and allow the LVS to contact me directly with your email--but it might take a few days for me to check in and I'd be unable to reply unless you provide a means.

  10. I noted that FINALLY the word is out. Nightly Business Report had a commentary by a Wall Street Journal reporter, missed the name. Anyhow, he explained, as I have, that when patients pay minimal to nothing for health care, they get lots of appointments, lots of RX.... But when you forget the copay and let them pay for the entire visit, they seek health care when they need it and not otherwise. So, as he said, insurance is for major medical problems--chronic conditions, emergencies, serious injury, that sort of thing. Preventive care too. And if you have a high-end insurance, you can have some copay for routine care. Otherwise, YOU pay as you go. There would be no need for rationing. Doctors in toto would be spot-on to respond to patient concerns and patient needs--or we'd go elsewhere. COSTS COME DOWN.

  11. Ms.Sick: I don't frequently read the untrusted posters. My top concerns do NOT include "helping everyone equally". Educating our youth has NOT been happening no matter how much we dump into K-12 and/or higher ed. And with your run-on sentence at 6:26 one cannot discern the subject. Who said anything about Christian or moral? Further, I went to war. I can do all the math. I'm still self supporting. I suppose your SS disability is based on inability to concentrate or focus your mind--based on content of your endless posts--what is that irony? Accusing others of ad nauseum while you go on and on about poor little you.