I’m a researcher: How Pa’s Medicaid expansion went beyond just data and touched my life | Opinion

August 4, 2019 6:30 am

By Diana Polson

Brenda is my mother-in-law. She is a 63-year-old woman born and raised in the Harrisburg area. When I think of the qualities that define her, they are tough, caring, funny, and a hard worker. She loves her kids, her grandkids and has an immaculate garden. (Seriously, you need to see it to believe it.)

She has worked hard her whole life—as a waitress, a massage therapist, a painter, a gardener—and she continues today to work odd jobs to make ends meet.

She, along with her sister, who together we’ve dubbed “Team Extreme” because of their renovation skills and drive, are masters of transforming spaces into places of comfort and beauty. I know because every time she visits us in Pittsburgh, she has a project. Our house, and lives, are made better because of her love, company, and hard work.

I talk about Brenda, and what she means to our family, because I believe it brings to life the numbers behind a recent study that was released via the National Bureau of Economic Research. I’m a policy analyst and researcher and often exist in the world of data and numbers. But too often these numbers are disconnected from real lives, connections, and people.

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Researchers in this new study found evidence that Pennsylvania’s decision to expand Medicaid has averted 1,467 deaths of near-elderly (ages 55-64) low-income individuals in Pennsylvania. That is 369 lives saved a year. Out of 31 states included in the study that have expanded Medicaid, Pennsylvania’s expansion has saved the second most number of lives, second only to California.

Brenda is one of the nearly 700,000 people who have benefited from Medicaid expansion in PA. And she has needed it in the last several years, having faced multiple health scares that have landed her in the hospital and in need of regular care.

Source: Pennsylvania Budget & Policy Center

I have no doubt that having Medicaid has improved her overall health and possibly even saved her life. In the past, at her sickest, she has had to make calculations in her mind about the cost of getting care vs. the risks of not getting care, too closely toeing that line.

These kind of life and death calculations are strikingly common in our state and country due to our broken health care system.

It has been well established that the annual mortality rate for low-income individuals is significantly higher than that of higher income individuals. For the near-elderly (aged 55-64) who earn less than 138% of the federal poverty line, the annual mortality rate is 1.6 percent.

This is nearly 2.3 times higher than the rate (0.7 percent) of higher income people of the same age. This group of people experience much higher rates of death from diabetes, cardiovascular disease, and respiratory disease, all of which can often be mitigated with medication.

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The study examined data before and after Medicaid expansion and found that, prior to expansion, states had similar trends in Medicaid coverage and mortality for this near-elderly population.

After expansion, however, the coverage and mortality rates began to diverge. Each year after expansion, the probability of mortality declined significantly for this population in Medicaid expansion states, signaling that longer periods of health coverage results in improved health outcomes.

The results are simple, yet so important. Access to Medicaid can help to reduce these disparities by ensuring low-income people have access to preventative care, life-saving prescription drugs, and early detection of disease like cancer.

Not expanding Medicaid has had deadly consequences. Researchers estimate that 15,600 deaths between 2014 and the end of 2017 could have been avoided had all states decided to expand Medicaid coverage.

Recent efforts by the Trump administration threaten the future of the Affordable Care Act and Medicaid expansion in Pennsylvania and elsewhere. The U.S. Court of Appeals for the Fifth Court is reviewing a decision by the Northern District of Texas that would invalidate the entire Affordable Care Act because the individual mandate was eliminated in the 2017 Tax Cuts and Jobs Act.

Medicaid expansion in our state has literally been a life-saver. My mother-in-law, my partner’s mom, my kids’ “meemaw” might have been, God forbid, one of those 1,467 lives that could have been lost had Pennsylvania chosen not to expand Medicaid. And what a loss to our family, and to the world, that would be.

Medicaid expansion is important. But it is also not enough. I think about all of those lives ended early because of a lack of care, because of the high cost of care, and because individuals lacked insurance or were underinsured. Here, in the richest country in the world.

Was it your brother, mother or wife? Could it be?

We need to get the profit motive out of our healthcare system and make health care accessible and free to every human being in this country. Anything less is an early death sentence to our beloved and a loss beyond repair.

Diana Polson is a policy analyst with the Pennsylvania Budget & Policy Center, a progressive think-tank in Harrisburg. 

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