Basic Math

nc.gifWhen the Affordable Care Act was passed in 2008, the idea was to cover as many previously uninsured folks as possible. What was the rational for this? Aside from it just being the right thing to do, research shows a strong connection between mortality rates and insurance status, and President Obama had the wild idea that less dead people was probably good thing.

Overall, the uninsured are more likely to have poor health and higher mortality rates than those with insurance. People without insurance are less likely to receive preventive services and more likely to delay or go without necessary doctors’ visits, prescription medicines, and other treatments that reduce unnecessary morbidity and premature death. As a result, this group has poorer health outcomes, a lower quality of life, and more premature deaths. The uninsured are also at greater risk of death following a trauma, heart attack, or stroke.

But at least 13 states, including North Carolina, have indicated they will not expand Medicaid and several more are on the fence, posing a substantial threat to the ACA’s expansion of insurance coverage for the most economically vulnerable Americans.

How many people would be affected according the study in North Carolina? An estimated 1,098 people will die a premature death this year as a result of no expansion of Medicaid in North Carolina.

The New England Journal of Medicine published a study late last year that demonstrates the life-saving potential of Medicaid coverage for low-income Americans. The study analyzed the effects of Medicaid expansion on adult morality in several states that had expanded coverage before the Affordable Care Act and found that Medicaid expansion was associated with a 6 percent reduction in mortality over five years for adults between the ages of 20 and 64. In other words, for many Americans, the difference between having access to Medicaid and not having access to Medicaid may literally be the difference between life and death.

The study adds to a growing body of research that demonstrates the (fairly intuitive) correlation between insurance, access to health care, and averted mortality. The Institute of Medicine, the Urban Institute, and other researchers and experts have documented either the potentially life-saving effect of Medicaid coverage or increased mortality rates among the poor and uninsured. While study design of the New England Journal piece cannot demonstrate with finality that Medicaid directly reduced the number of deaths in each state, it represents a methodologically rigorous assessment that rules out many of the other plausible explanations for the decreased death rate in states that expanded Medicaid coverage compared to those that did not expand coverage.

Medicaid protects the most vulnerable people in our society — children, pregnant women, seniors, and people with disabilities. Not surprisingly, the NEJM study found that mortality reductions were greatest among non-whites and residents of poorer counties. People of color represent 57 percent of the total Medicaid population and the majority of people that receive coverage through Medicaid are low-income women and children.

The American people are being presented with two very different visions for the future of our health care system: one in which the ACA is fully implemented and 17 million low-income Americans gain access to the health care they need and another, outlined in the GOP budget, which would repeal the ACA and decimate the Medicaid program converting it into a block grant.

The NEJM study reminds us what’s at stake in the current battle over Medicaid expansion: this fight is about ensuring basic human rights for American citizens. 

Think it's time for Governor McCrory to think twice about his decision to torpedo Medicaid expansion? So do we - sign the petition and let him know he needs to think about what is best for ALL of North Carolina!