Reference no: EM134003727

Question

Was Medicaid Expansion Worth It?

The Affordable Care Act was designated to extend Medicaid to low-income individuals and families, but court decisions allowed states to opt out of Medicaid expansion. As of 2020, 38 states had expanded Medicaid coverage. Did the benefit of expansion exceed its costs? A detailed analysis concluded that the benefits of expansion substantially exceeded its cost while also making clear the complexity of the calculations. Borgschulte and Vogler (2020) (article is attached) compared changes in mortality in expansion-state counties to changes in mortality in matched, non-expansion-state counties. Although mortality rates declined in all states between 2013 and 2017, by 2017, mortality rates fell by 15 additional people per 100,000 in expansion states. Thus, the authors concluded that the expansion reduced mortality for those under age 65 by just over 12,000. Using the value of a statistical life (an estimate based on the effects of market choice on mortality risks; see EPA 2020), they estimated the value of Medicaid expansion at $102 billion. Medicaid expansion costs 70 billion, meaning that the benefits were greater than the costs.

Discussion Questions

1. Why might mortality have fallen between 2013 and 2017 in non-expansion states?
2. How would having insurance coverage reduce mortality?
3. Are there benefits to insurance coverage other than reducing the risk of premature death?
4. Why might Medicaid expansion affect people who did not gain coverage as a result?
5. What sort of analysis is this?