In her State of the State address, Gov. Nikki Haley summarized her opposition to Medicaid expansion under the Affordable Care Act by asking, “Why would we throw more money at the system without first demanding improved efficiency, quality, and accessibility?”
One problem with this stand is that there are no affordable insurance alternatives for those uninsured South Carolinians who would qualify under an expanded Medicaid program so they will continue to be a burden on the South Carolina health care delivery system.
While the negative economic impact on hospitals and other providers is predicted to be significant if the governor follows through with her plan to opt out, there is one other significant factor that is often overshadowed by political posturing, the impact on life expectancy.
A study conducted by the Department of Health Policy and Management at the Harvard School of Public Health, published in the July 25, 2012 edition of the New England Journal of Medicine, compared death rates between states that have expanded Medicaid eligibility and states that have not. Their findings show that in states that have expanded Medicaid eligibility there is, on average, a decrease in the adjusted all-cause mortality rate of 6.1 percent.
Another study published in the August 2012 issue of Health Affairs highlights the decrease in life expectancy in the less educated poor white population. One factor is the correlation between education and access to health care.
On average, whites who do not have a high school diploma lost four years of life expectancy since 1999. The highest loss of life expectancy was among white women with less than a high school diploma who lost an average of five years.
The fundamental message from these recent studies is that there is a direct correlation between access to health care and life expectancy.
What does this mean for South Carolina?
Data published in the South Carolina Detailed Mortality Statistics 2009 by DHEC in September 2011, indicates there were 40,242 deaths in South Carolina during 2009.
At a rate of 6.1 percent, compared to those states that have expanded Medicaid programs, there could have been a decrease of as many as 2,455 deaths in South Carolina in 2009 if the state had an established expanded Medicaid program.
Regardless of the political arguments made by those opposed to the Affordable Care Act, the decision to opt in or opt out of the expanded Medicaid program is a simple matter of life and death.
Doctor of Public Health
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