As the North Carolina NAACP holds a “Denial of Medicaid Funeral Procession” today, it’s worth considering some of the facts and data surrounding the impact of North Carolina’s ongoing refusal to expand Medicaid under the Affordable Care Act:
The North Carolina Institute of Medicine’s 2009 Access to Care study begins with this statement: “The lack of health insurance coverage is the foremost barrier to accessing health care services.”
In the report’s introduction it continues:
In a statewide survey of adults, nearly half of the uninsured in North Carolina reported forgoing necessary care due to cost, compared to 10% of individuals with insurance coverage. Lack of coverage also adversely affects health as the uninsured are less likely to get preventive screenings or ongoing care for chronic conditions. Consequently, the uninsured have a greater likelihood than people with coverage of being diagnosed with severe health conditions (such as late stage cancer), being hospitalized for preventable health problems, or dying prematurely. In fact, adults who lack insurance coverage are 25% more likely to die prematurely than adults with insurance coverage.
A Families USA report in 2010 estimated that before the Affordable Care Act passed nearly 1,000 North Carolinians died each year between 2005 and 2010 due to lack of health insurance.
What has changed is that the states now have an unprecedented tool for saving lives. North Carolina now has the opportunity to extend health insurance coverage to nearly all low-income adults, the majority of whom are working. The federal government will finance nearly the entire cost of this coverage expansion. Not expanding coverage is not only morally misguided but it is also fiscally irresponsible.
We now have more estimates of the number of deaths that we can directly attribute to the lack of Medicaid expansion.
In 2012 researchers from the Harvard School of Public Health published a study in the New England Journal of Medicine that examined the health impacts on states that expanded Medicaid coverage to childless adults between 2000 and 2005. They found reduced mortality rates in states that expanded coverage amounting to 2,840 deaths prevented per year for each 500,000 adults gaining Medicaid coverage. Mortality reductions were greatest for racial and ethnic minorities and residents of the poorest counties.
In 2014 researchers from Harvard and the City University of New York combined data from the Oregon Health Insurance Study and two larger examinations of mortality and lack of health insurance to project that between 455 and 1,145 North Carolinians will die every year without expansion.
All of these estimates are the direct health impacts on adults. They do not take into account the reduction in infant mortality rates that stem from increases in insurance coverage. And these studies do not include indirect impacts, such as hospital closures, that kill people who lack access to nearby emergency services.