When Pennsylvania and 24 other states opted out of—or delayed opting into—the Medicaid expansion, they put a lot of lives on the line. Hundreds of thousands of Pennsylvanians would have gained health insurance on Jan. 1 had the state accepted the federal money offered under the Affordable Care Act. Instead, less than a month earlier, Gov. Corbett proposed an alternative plan using federal dollars to subsidize commercial insurance plans that is so complex and requires so many waivers of federal law that even the governor didn’t project it could start until Jan. 1, 2015. Approval of the draft form that was released to the public is extremely unlikely.
Now comes a study, published on the Health Affairs blog,that reveals the consequences. “We estimate the number of deaths attributable to the lack of Medicaid expansion in opt-out states at between 7,115 and 17,104,” the authors write. In Pennsylvania, the annual estimated death toll ranges from 398 to 1,491. That’s right. We have rejected the chance to save lives and health. That is immoral.
It is also fiscally stupid. Medicaid expansion would be entirely paid for by the federal government for three years–2014, 2015, and 2016, so Pennsylvania will get no more than two of them–and phasing down to 90 percent in 2020. And it saves money for the states.
Health is a state of physical, mental and social well-being, not merely the absence of disease or infirmity. Preserving health requires screenings and, if needed, treatments. So, what are the health consequences (besides death) of opting out of Medicaid?
As the study’s authors put it: “Medicaid expansion in opt-out states would have resulted in 712,037 fewer persons screening positive for depression and 240,700 fewer individuals suffering catastrophic medical expenditures. Medicaid expansion in these states would have resulted in 422,553 more diabetics receiving medication for their illness,195,492 more mammograms among women age 50-64 years and 443,677 more pap smears among women age 21-64. Expansion would have resulted in an additional 658,888 women in need of mammograms gaining insurance, as well as 3.1 million women who should receive regular pap smears.”
Those are nationwide annual figures. A table in the Health Affairs study estimates the numbers, state by state, column by depressing column. In Pennsylvania it means 435,088 people continuing to lack health insurance, including: 39,811 with depression; 23,625 diabetics; 12,484 women in need of a mammogram and 23,881 due for a pap smear; and 12,780 people with “catastrophic medical expenditures.”
Why is Pennsylvania still considering submitting a waiver application for its proposed “Healthy Pennsylvania” Medicaid expansion? Why not just go ahead and expand Medicaid, as every surrounding state has done? We can save lives; promote health, save money—and do that year after year after year. What are we waiting for?
Read more about The Public's Health.