Death Rates Shape Health Debate

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The often-bitter debate about whether to expand the Arizona Health Care Cost Containment System (AHCCCS) with federal funds turns in part on dueling studies on death rates among patients.

One set of studies concluded such programs cut death rates by about 6 percent.

But a study by researchers from the University of Virginia found Medicaid surgical patients not only had a far higher death rate than privately insured patients — but a slightly higher death rate than uninsured surgical patients.

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Gov. Jan Brewer

Arizona critics of the federal Affordable Care Act, like state Rep. Brenda Barton (R-Payson), have cited the University of Virginia study in support of their opposition to adding roughly 350,000 people to the AHCCCS rolls.

This expansion of Medicaid accounts for about half of the 32 million people expected to get health insurance under the terms of “Obamacare.”

Gov. Jan Brewer supported the expansion, insisting it will inject $2 billion annually into the economy. If the federal match falls below 90 percent in the future, the state would drop the added patients.

Most of the state’s hospitals agreed to a $240 million annual surcharge to cover all the state’s costs in expanding the program, in hopes the expanded coverage will reduce the uncollectible emergency room bills.

Critics of the expansion have frequently cited the University of Virginia study, which they say proves that having Medicaid coverage is worse than having no coverage at all.

That study reviewed the outcomes of nearly 1 million major surgical operations nationwide between 2003 and 2007. The researchers compared adjusted outcomes for people covered by private insurance, Medicare (for retirees), Medicaid (for the poor) and people without any insurance at all. The researchers took into account as many as 30 complicating factors.

Before adjusting for other factors, Medicare patients had a death rate of 4.4 percent, uninsured patients 3.2 percent, privately insured patients of 1.3 percent and Medicaid patients of 3.7 percent.

Once the researchers factored in those 30 variables, the gap grew much wider. The odds a Medicaid patient would die was 97 percent higher than for privately insured patients, but the odds an uninsured patient would die was only 74 percent higher.

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Rep. Brenda Barton

Many critics of AHCCCS say the study shows that the state’s coverage actually increases the risk of death compared to having no insurance at all.

Other medical experts maintain the University of Virginia study didn’t take into account big differences between Medicaid patients and either privately insured patients or uninsured patients. People on AHCCCS tend to have worse health, less education and more other illnesses. Other studies suggest Medicaid patients wait longer to seek treatment, which means they’re at more advanced stages of disease. Often, people can’t get on AHCCCS until their medical bills have already bankrupted them.

In fact, a number of studies have led experts to conclude that adding an estimated 17 million people to the Medicaid rolls nationally will save lives. Previous studies have suggested a lack of insurance causes 60,000 premature deaths in the U.S. annually.

The most recent study looked at what happened when Arizona and two other states expanded their Medicaid programs. In Arizona’s case, voters approved the expansion of the program to cover childless adults in addition to impoverished families and nursing home residents. Two years ago, the Legislature set aside that voter-approved expansion and dropped those residents from the program.

But the Harvard researchers concluded the expansion of the program had saved lives in Arizona, Maine and New York, according to the study published in the New England Journal of Medicine.

The researchers examined mortality rates in those three states for the five years before and after the expansion of their Medicaid programs — and compared the trend to Pennsylvania, Nevada, New Mexico and New Hampshire, which did not expand their low-income health plans.

The figures revealed that death rates declined in the three states that expanded their programs, but rose in the neighboring states. Overall, the states that expanded their Medicaid programs saw a 6 percent decline in death rates — or about 2,850 for every 500,000 adults added to the AHCCCS rolls.

The study suggests the state can prevent one premature death for every 176 people added to the program. A Congressional Budget Office study estimated adding a person to the program costs an average of $6,000 annually — a cost of $1 million for each life saved.

Another study came to similar conclusions, this one based on Oregon’s use of a lottery system to decide who would get added coverage in 2008. The study compared the 10,000 people who got coverage to people who had applied, but didn’t win the health lottery. The patients who got on the program saw doctors more often, had better health, fewer delays in getting care and more financial stability.

Medical bills remain the single greatest cause of bankruptcy.

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