Health Care

Kaitlyn Finley | December 17, 2019

Medicaid ‘mortality’ study bears closer scrutiny

Kaitlyn Finley

A new study from a national progressive think tank, the Center on Budget and Policy Priorities (CBPP), estimates that “over a four-year period, the lives of 476 older people were lost because Oklahoma did not expand Medicaid to low-income adults.”

However, upon closer examination, it becomes clear the CBPP’s estimates are on shaky ground.    

The CBPP’s projections are based on a new working paper entitled “Medicaid and Mortality,” published by the National Bureau of Economic Research (NBER). The study attempts to compare mortality rates among adults ages 55 to 64 between states that did and did not expand Medicaid eligibility under the Affordable Care Act.

The authors of the study claim their report is empirically superior to previous studies because they were able to match hundreds of thousands of death records with low-income individuals in non-expansion states who would have qualified for Medicaid.

In their study, researchers conclude that Medicaid coverage seemingly reduces mortality rates among low-income individuals.  

However, later in the study, the authors make an important admission—their data set was not able to take into account the cause of death.

The study said a “limitation is that our data do not include information on the cause of death.” The researchers did not know if individuals in their large data set died from injuries, car accidents, infectious diseases, or any type of chronic condition. They merely recorded each nameless participant as a 1 or 0—dead or alive—each year from 2013 to 2017. In order to take into account the cause of death, the authors had to drastically reduce the sample size in their study.

“While this drastically reduces both the sample size and follow-up period, it does allow us to conduct exploratory analyses of changes in mortality based on the underlying cause of death as reported on the death certificate…These analyses rely on a much smaller sample and shorter follow-up period, and so we consider this analysis to be exploratory in nature.”

The study was also not able to make a true apples-to-apples comparison between the demographic groups studied in expansion and non-expansion states regarding baseline income, race, education level, and insurance status.

It’s clear this “landmark” observational study and its bold conclusions warrant a closer look.  

Other, more robust experimental studies have shown contradicting results regarding the effectiveness of Medicaid coverage. In fact, in some cases, Medicaid coverage has been linked to worse health outcomes for certain medical procedures.

Throughout the report, the authors reference the well-known 2008 Oregon Health Insurance Experience (OHIE). In this randomized experimental controlled trial (regarded as the gold standard in controlled academic studies), researchers were able to track a plethora of health measures of specific individuals who gained Medicaid coverage through a state lottery-type program compared to those who did not. After two years, researchers found “no significant improvements in measured physical health outcomes” for those who gained Medicaid coverage for the duration of the experiment. Data show that simply offering more coverage to individuals does not automatically result in better health outcomes.

In “Medicaid and Mortality,” the authors make other interesting observations regarding overutilization and potential Medicaid fraud, undercutting CBPP’s efforts to expand Medicaid eligibility.

In their report, the researchers note that states that have expanded Medicaid have seen an increase in emergency-care use. “Furthermore, Medicaid coverage increases the number of hospitalizations…and the number of emergency department visits for conditions that require immediate care.” But federal law already requires hospitals to administer emergency care to all, whether they are insured or not. Taxpayers covering individuals who continue to overutilize emergency care will only result in higher tax bills and medical bills for all payers.   

In one of the study’s placebo tests, the authors observed that there was a “small but statistically significant” increase in Medicaid enrollment among individuals ages 55 to 64 who were earning 400 percent of the federal poverty level or greater.

There is only one problem—these individuals are not eligible for Medicaid due to their income. Only those who make less than 138 percent of the federal poverty level are eligible for Medicaid coverage under expansion according to the Affordable Care Act. That means some folks are signing up for Medicaid who are not eligible—quite a few—according to other recent data.

Another study published last August by NBER found that in nine expansion states “around 800,000 individuals…appeared to gain Medicaid coverage for which they were seemingly income-ineligible” in 2017. This matters because every ineligible individual on Medicaid siphons state and federal dollars from truly needy Medicaid recipients.

Rather than uncritically accept sensationalized “Medicaid death” headlines, Oklahomans should carefully consider all the facts before supporting an irreversible and costly expansion of welfare to hundreds of thousands of able-bodied adults in Oklahoma.

Kaitlyn Finley Policy Research Fellow

Kaitlyn Finley

Policy Research Fellow

Kaitlyn Finley currently serves as a policy research fellow for OCPA with a focus on healthcare and welfare policy. Kaitlyn graduated from the University of Science and Arts of Oklahoma in 2018 with a Bachelor of Arts in Political Science. Previously, she served as a summer intern at OCPA and spent time in Washington D.C. interning for the Heritage Foundation and the U.S. Senate Committee on Environment and Public Works.

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