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Vital Signs Blog

Blog: Rating a politician's claim that Medicaid kills

One of Florida's most powerful Republicans reportedly is using the results of a narrow study focusing on surgical outcomes to insinuate that extending Medicaid to more Americans increases their chances of dying.

Rep. Richard Corcoran is leading the battle in Florida to block a bill approved by the GOP-led state Senate to expand Medicaid to low-income adults. The Senate's conservative expansion model includes reliance on private plans, premium contributions, work requirements and a six-month cut-off of benefits for nonpayment of premiums.

Corcoran, the House Appropriations Committee chairman, recently told his colleagues that he “will proudly declare war on… all the Gucci-loafing, shoe-wearing special interests” that want to expand Medicaid. That presumably means Florida hospital leaders, who have strenuously pushed for expansion.

As part of that “war,” when his constituents email him about the expansion issue, PolitiFact Florida reported, Corcoran sends this reply: "The largest national study, conducted by the University of Virginia, found that Medicaid patients were 97% more likely to die than those with private insurance."

PolitiFact Florida rated Corcoran's statement to his constituents as “mostly false.”

“Mostly false” seems charitable given what PolitiFact went on to say about the 2010 study, which focused solely on Medicaid patients who underwent major surgery. “Experts we spoke to -- including one of the study's authors -- said it's a misleading statistic to cite,” PolitiFact wrote. “While it's accurate to say Medicaid patients who undergo operations have higher odds of dying than those with private insurance, it's because they are sicker and tend to wait until the last minute for care, not because the program is inadequate.”

Even back in 2011, research experts debunked efforts by conservative writers to use this study to prove that having Medicaid is bad for people.

This is hardly the first time opponents of Obamacare and Medicaid expansion have contended that extending health coverage to uninsured people doesn't do them any good. You might have thought this issue was on its way to being settled by a landmark study published last year in the Annals of Internal Medicine. It found that the death rate in Massachusetts dropped significantly after that state adopted mandatory coverage in 2006.

The researchers reported the number of deaths per 100,000 residents fell by about 3% in the four years after the state's healthcare reform law went into effect. The drop was sharpest in Massachusetts counties with the highest percentages of poor and previously uninsured people. In contrast, the death rate in similar counties in other states that did not expand coverage was largely unchanged during that period.

In addition, a 2013 study published in the New England Journal of Medicine found that among Oregon residents who gained Medicaid coverage during a 2008 lottery, the rate of depression was lower compared with residents who didn't get covered, and the Medicaid beneficiaries enjoyed greater financial protection from medical bills. Those Oregonians with Medicaid visited doctors' offices more often and had more prescriptions compared with those who didn't get covered. The researchers, however, found no greater detection of hypertension or high cholesterol among the group that gained coverage.

“Putting the evidence together paints a very strong picture that expanding insurance substantially improves the well-being of people who get it,” Katherine Baicker, a health economist at the Harvard School of Public Health who was involved in both studies, told the New York Times.

Does Rep. Corcoran ever get out and talk to low-income Floridians who either are uninsured or struggle with the costs of keeping their insurance? He might want to read a recent Miami Herald/Kaiser Health News article describing the plight of Isabel Betancourt, a plucky 31-year-old Miami-area college student who suffers from debilitating juvenile rheumatoid arthritis. She needs to take an expensive immune system inhibitor for her condition.

Betancourt's income from her part-time job is below 100% of the federal poverty level, making her ineligible for the Affordable Care Act's premium subsidies to buy a private plan on the exchange. And she doesn't qualify for Medicaid because that state so far has refused to expand income eligibility.

After months of being uninsured and not being able to afford her medication, she's struggling to pay the $192 monthly premium for the high-deductible health plan she bought on her own. That's about 25% of her income. Her car recently needed $350 in repairs, leaving her $11 in pocket money for two weeks. Even with insurance, she can't afford to pay the $6,000 deductible to have her left shoulder replaced, as her doctors recommended. Asked why she doesn't ask her family for help, she said: “I'm too old to be asking dad. I can't be running to dad when he's already spread thin.”

Is it only “mostly false” for Corcoran to tell constituents that Medicaid is likely to kill people? Can anyone honestly argue that Betancourt and millions of other Americans in the coverage gap wouldn't be better off if Corcoran and GOP leaders across the country extended coverage to them?






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