Study Calls Wide Mass. Coverage a Lifesafer
by Deborah Kotz
May 05, 2014
Source: The Boston Globe
The groundbreaking Massachusetts health insurance law may have prevented about 320 deaths a year, according to a Harvard study of the legislation that was used as a model for President Obama’s national health program.
The researchers from the Harvard School of Public Health, in a study published Monday, estimated that the law, which expanded coverage to most residents, has saved about one life for every 830 people who enrolled in health insurance.
“This is a strong and credible finding,” said Austin Frakt, a health economist at Boston University School of Medicine who wrote an editorial that accompanied the study. “I think there’s enough evidence at this point to conclude that health insurance does improve health and mortality.”
During the four years after Massachusetts implemented the 2006 law, death rates in the state dropped by nearly 3 percent among young and middle-age adults compared with similar populations in states that did not expand coverage, the researchers concluded.
Some health policy specialists were dubious about attributing the decline in deaths to the law. “I am skeptical that such an immediate and significant drop in mortality would occur after getting health insurance,” said Dr. Scott W. Atlas, a senior fellow at Stanford University’s Hoover Institution.
Previous studies investigating whether health insurance led to fewer deaths have yielded mixed results. Researchers have observed that increasing Medicaid coverage to low-income people in certain states led to a drop in death rates, but an ongoing study of Oregon residents who were randomly assigned to get health coverage or not has found no difference in death rates. Facing a funding shortfall, Oregon in 2008 picked people by lottery for its Medicaid program, creating the unusual opportunity to conduct a randomized study of health insurance — which is the gold standard of health research.
The latest study, published Monday in the Annals of Internal Medicine, used a different methodology that did not allow researchers to firmly establish the cause of the observed reduction in deaths in Massachusetts. It looked at changes in death rates among adults ages 20 to 64 in Massachusetts before the state’s health law overhaul, from 2001 to 2005, and after, from 2007 to 2010.
“Our aim was to analyze young and middle-aged adults, the main group that didn’t have health insurance before the health law was passed,” said study leader Dr. Benjamin Sommers, an assistant professor of health policy and economics at the Harvard School of Public Health.
The researchers compared the changes in death rates in Massachusetts with what happened in counties across the country with comparable populations — with similar ages, socioeconomic status, and health insurance rates before 2006 — that were located in states that had not expanded insurance coverage. The mortality rates in those counties remained unchanged during the time period during which they fell in Massachusetts.
Elderly adults in Massachusetts, who mostly have Medicare coverage, also experienced no significant drop in their death rates compared with other states. This finding, in contrast to the death-rate decline among younger adults who were mostly likely to gain coverage, “suggests to us that health reform was the likely explanation,” Sommers said.
Adding strength to the finding was a larger drop in deaths due to preventable causes, such as heart disease, diabetes, cancer, and infections, compared with deaths that would not have been affected by health insurance, such as those caused by accidents, suicides, or acts of violence. The researchers found nearly a 5 percent decrease in the death rate for preventable causes.
“When more people gain access to insurance coverage, they gain better ways to use the health care system and have improved health outcomes,” said Diane Rowland, executive vice president of the Kaiser Family Foundation, a nonprofit health policy organization based in California. “Uninsured people don’t seek care as early as they need to, which can lead to death.”
A decade-old report from the Institute of Medicine estimated that 18,000 Americans die every year due to lack of health insurance, but that has been difficult to document in studies.
“If this turns out to be true, it’s good news, but it may not be true,” said John Goodman, president of the National Center for Policy Analysis, a public policy think tank based in Dallas.
The Oregon study, led MIT and Harvard researchers, found that after about two years, those given health insurance did not experience beneficial changes in blood pressure or their blood sugar levels compared with uninsured participants. But people with coverage perceived that their health had improved and their rates of depression declined.
Other studies looking at states that expanded Medicaid coverage found a 6 percent drop in mortality rates.
“All studies have limitations,” Rowland said, “and measuring the exact effect of health insurance has been difficult, but we do know it makes a difference in people’s lives and in their ability to lead a longer one.”