The ACA wasn't perfect, but where implemented it saved lives.. this paper shows, as other studies have, that and estimates the lives that could have been saved if Republican states allowed the ACA Medicaid expansions. But Obamacare is evil to them and tax cuts for the rich are the only worthy goal of any legislation.
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Our analysis shows that the ACA Medicaid expansions reduced mortality among this targeted group. Prior to the expansions, individuals in our sample residing in expansion and non-expansion states had very similar trends in both Medicaid coverage and mortality. At the time of the expansion, the trajectories of these two groups diverged significantly, with expansion state residents seeing increases in Medicaid coverage and decreases in the probability of being uninsured, and decreases in annual mortality rates. In the first year following the coverage expansion, the probability of mortality declined by about 0.09 percentage points, or 6.4 percent relative to the sample mean. The estimated impact of the expansions increases over time, suggesting that prolonged exposure to Medicaid results in increasing health improvements. By year 4, residents of expansion states have an annual mortality rate that is 0.2 percentage points lower than their non-expansion state counterparts. In our supplemental analysis using the MDAC data, we find evidence that healthcare amenable and internal causes of death were reduced by the expansions, but no evidence that deaths due to external causes, such as car accidents, fell. We also conduct several placebo tests to assess the validity of our analysis including examining the impact of the expansions on those age 65 or older in 2014 who did not gain Medicaid eligibility; examining the effect on individuals in higher income households who were less likely to be affected; and, restricting the analysis sample to the pre-ACA period. We find no relative change in coverage or mortality across expansion and non-expansion states among the elderly or in the pre-ACA period, settings in which no Medicaid expansion occurred. Among those in higher income households, we find small but statistically significant increases in Medicaid coverage and similarly small decreases in mortality, consistent with a causal impact of Medicaid on mortality.
Our analysis provides new evidence that Medicaid coverage reduces mortality rates among low- income adults. Our estimates suggest that approximately 15,600 deaths would have been averted had the ACA expansions been adopted nationwide as originally intended by the ACA. This highlights an ongoing cost to non-adoption that should be relevant to both state policymakers and their constituents.
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