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State Medicaid Expansions and Mortality, Revisited: A Cost-Benefit Analysis

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  • Benjamin D. Sommers

    (Department of Health Policy and Management, Harvard T. H. Chan School of Public Health)

Abstract

Previous research found that Medicaid expansions in New York, Arizona, and Maine in the early 2000s reduced mortality. I revisit this question with improved data and methods, exploring distinct causes of death and presenting a cost-benefit analysis. Differences-in-differences analysis using a propensity score control group shows that all-cause mortality declined by 6 percent, with the most robust reductions for health-care amenable causes. HIV-related mortality (affected by the recent introduction of antiretrovirals) accounted for 20 percent of the effect. Mortality changes were closely linked to county-level coverage gains, with one life saved annually for every 239 to 316 adults gaining insurance. The results imply a cost per life saved ranging from $327,000 to $867,000 which compares favorably with most estimates of the value of a statistical life.

Suggested Citation

  • Benjamin D. Sommers, 2017. "State Medicaid Expansions and Mortality, Revisited: A Cost-Benefit Analysis," American Journal of Health Economics, MIT Press, vol. 3(3), pages 392-421, Summer.
    • Handle: RePEc:tpr:amjhec:v:3:y:2017:i:3:p:392-421
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    File URL: http://www.mitpressjournals.org/doi/pdf/10.1162/AJHE_a_00080
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    13. Lisa A. Robinson, 2007. "Policy Monitor How US Government Agencies Value Mortality Risk Reductions," Review of Environmental Economics and Policy, Association of Environmental and Resource Economists, vol. 1(2), pages 283-299, Summer.
    14. Sommers, Benjamin D. & Oellerich, Donald, 2013. "The poverty-reducing effect of Medicaid," Journal of Health Economics, Elsevier, vol. 32(5), pages 816-832.
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    Cited by:

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    2. Charles Courtemanche & James Marton & Benjamin Ukert & Aaron Yelowitz & Daniela Zapata, 2018. "Early Effects of the Affordable Care Act on Health Care Access, Risky Health Behaviors, and Self‐Assessed Health," Southern Economic Journal, John Wiley & Sons, vol. 84(3), pages 660-691, January.
    3. Sarah Miller & Norman Johnson & Laura R Wherry, 2021. "Medicaid and Mortality: New Evidence From Linked Survey and Administrative Data," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 136(3), pages 1783-1829.
    4. M. Taha Kasim & Benjamin Ukert, 2021. "The impact of WIC participation on tobacco use and alcohol consumption," Contemporary Economic Policy, Western Economic Association International, vol. 39(3), pages 608-625, July.
    5. Craig Garthwaite & John Graves & Tal Gross & Zeynal Karaca & Victoria Marone & Matthew J. Notowidigdo, 2019. "All Medicaid Expansions Are Not Created Equal: The Geography and Targeting of the Affordable Care Act," Brookings Papers on Economic Activity, Economic Studies Program, The Brookings Institution, vol. 50(2 (Fall)), pages 1-92.
    6. Juanmarti Mestres, Arnau & López Casasnovas, Guillem & Vall Castelló, Judit, 2021. "The deadly effects of losing health insurance," European Economic Review, Elsevier, vol. 131(C).
    7. Broughel, James & Chambers, Dustin, 2021. "Federal Regulation and Mortality in the 50 States," Working Papers 10289, George Mason University, Mercatus Center.
    8. Broughel, James & Viscusi, Kip, 2017. "Death by Regulation: How Regulations Can Increase Mortality Risk," Working Papers 06864, George Mason University, Mercatus Center.
    9. Borgschulte, Mark & Vogler, Jacob, 2020. "Did the ACA Medicaid expansion save lives?," Journal of Health Economics, Elsevier, vol. 72(C).
    10. Rebecca M. Myerson & Reginald D. Tucker‐Seeley & Dana P. Goldman & Darius N. Lakdawalla, 2020. "Does Medicare Coverage Improve Cancer Detection and Mortality Outcomes?," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 39(3), pages 577-604, June.
    11. Mengna Luan & Wenjing Shi & Zhigang Tao & Hongjie Yuan, 2023. "When patients have better insurance coverage in China: Provider incentives, costs, and quality of care," Economics of Transition and Institutional Change, John Wiley & Sons, vol. 31(4), pages 1073-1106, October.
    12. Jim P Stimpson & Jessie Kemmick Pintor & Fernando A Wilson, 2019. "Association of Medicaid expansion with health insurance coverage by marital status and sex," PLOS ONE, Public Library of Science, vol. 14(10), pages 1-12, October.
    13. Jonathan Gruber & Benjamin D. Sommers, 2020. "Fiscal Federalism and the Budget Impacts of the Affordable Care Act's Medicaid Expansion," NBER Working Papers 26862, National Bureau of Economic Research, Inc.

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    More about this item

    Keywords

    Medicaid; health insurance; mortality;
    All these keywords.

    JEL classification:

    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • I38 - Health, Education, and Welfare - - Welfare, Well-Being, and Poverty - - - Government Programs; Provision and Effects of Welfare Programs
    • D31 - Microeconomics - - Distribution - - - Personal Income and Wealth Distribution

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