State Medicaid expansions show several benefits

In a study recently published in The New England Journal of Medicine,1 state Medicaid expansions to cover low-income adults were significantly associated with several benefits, including reduced mortality and improved coverage, access to care, and health, as self-reported.

In the past 10 years, several states have expanded Medicaid eligibility for adults. Heatlhcare reform is allowing states to make a dramatic expansion in Medicaid in 2014. “Yet the effect of such changes on adults’ health remains unclear,” the authors say.

They studied whether Medicaid expansions were associated with changes in mortality and other health-related measures. They compared New York, Maine, and Arizona because those states had substantially expanded their adult Medicaid eligibility in the past 12 years, and their border states had not expanded. Adults between age 20 and age 64 were observed from 1997 through 2007.

The primary outcome was all-cause county-level mortality among 68,012 year- and county-specific observations in the Compressed Mortality File of the Centers for Disease Control and Prevention. Secondary outcomes were rates of insurance coverage, delayed care because of costs, and self-reported health among 169,124 persons in the Current Population Survey and 192,148 persons in the Behavioral Risk Factor Surveillance System.

Medicaid expansions were linked to a significant reduction in adjusted all-cause mortality (by 19.6 deaths per 100,000 adults, for a relative reduction of 6.1%; P=0.001). Mortality reductions were greatest among adults with these characteristics: older, nonwhites, and residents of poorer counties. Expansions increased:

• Medicaid coverage by 2.2 percentage points, for a relative increase of 24.7%; P = 0.01;

• decreased rates of uninsurance by 3.2 percentage points, for a relative reduction of 14.7%; P < 0.001;

• decreased rates of delayed care because of costs by 2.9 percentage points, for a relative reduction of 21.3%; P = 0.002;

• increased rates of self-reported health status of “excellent” or “very good” (by 2.2 percentage points, for a relative increase of 3.4%; P = 0.04).


1. Sommers BD, Baicker K, Epstein AM. Mortality and access to care among adults after state Medicaid expansions. NEJM July 25, 2012. Accessed at