KHI News Service

The cost of not expanding Medicaid

By | February 06, 2013

Sheldon Weisgrau, director of Health Reform Resource Project.

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There are costs. And then there are costs.

Going to the hospital for an overnight stay will cost you something out of pocket, even with good insurance.

But not getting health care because you’re uninsured might cost you your life.

Health insurance saves lives. Despite the continued conflict and politics surrounding the Affordable Care Act, there is little dispute about that simple notion. And yet, the impact of insurance on the health and lives of those who have it – and those who don’t – often gets lost in the debate.

Last summer’s Supreme Court decision largely upheld the ACA. One exception was that expansion of the Medicaid program – KanCare in Kansas – was made optional for states. The governor and lawmakers are now considering whether to accept federal dollars to expand KanCare and provide insurance coverage to more Kansans.

Over the last few months, a number of organizations, some impartial, others biased, have published studies on the impact of KanCare expansion. Estimates for Kansas have been produced by the Kansas Health Institute, the Kaiser Family Foundation, the Urban Institute, and others. More are in the pipeline.

These studies devote hundreds of pages to analysis and discussion of the budget impact of expansion. They estimate the number of people that would be covered and the costs to the state and federal government.

What they don’t do is tell us why Medicaid and health insurance are important.

Perhaps it’s obvious. Common sense, as well as more than 25 years of research evidence, tells us that insurance coverage matters. People without health insurance are not as healthy as those with it.

They receive less preventive care and are sicker when diagnosed. After diagnosis, they receive less therapeutic care and fewer medications. The uninsured are more likely to have chronic illnesses and less likely to have them under control. They have more difficulty holding jobs and earn less than those with insurance. They don’t live as long.

These findings hold whether we’re talking about adults or kids, women or men, whites or other racial and ethnic groups. To put it simply, compared to people with health insurance, the uninsured are sicker, poorer, and more likely to die. We also know that becoming insured lessens or reverses many of these harmful effects.

There is even a growing body of evidence that large numbers of people without insurance affect the health and health care of those with coverage. Insured people who reside in communities with a high rate of uninsurance have more difficulty getting needed services, are less likely to have a usual source of care, and are less satisfied with the care they receive.

Yet we debate this issue as if it’s simply a matter of dollars and cents. Budgets and deficits and tax rates are important public policy issues – to many people, the most important. But our accounting should weigh both the costs and the benefits.

A recent study published in the New England Journal of Medicine makes this point. Researchers from the Harvard School of Public Health compared adults in states that have expanded Medicaid over the past decade to those in neighboring states that did not expand.

Expansion did more than improve access to care and enhance health, according to the researchers. For every 176 adults who received Medicaid coverage each year through expansion, one death was prevented.

The Kansas Health Institute estimates that more than 76,000 uninsured adults would enroll in KanCare if Kansas expands the program under the ACA. The Harvard data suggests that 432 people would, as a result, survive.

As we consider the costs of KanCare expansion, let’s not forget the human costs of not expanding.

— Sheldon Weisgrau is the director of Health Reform Resource Project. The opinions in the columns solely reflect those of the author. They aren't endorsed by the Kansas Health Institute, which seeks a broad range of opinion to stimulate discussion.