From Esquire

On June 28, 2012, the day that the Supreme Court upheld most of the Affordable Care Act, the sighs of relief were so loud that they drowned out one part of the Court's decision that has come to haunt the lives of millions of poor people around the country, and that also has come to represent the fanatical refusal of Republican politicians, specifically Republican governors, to associate themselves with anything that had anything to do with President Barack Obama. In his opinion upholding the ACA, Roberts allowed individual governors to refuse to accept the Medicaid expansion in their states. In other words, just because it came from an Democratic president—and because it came from that Democratic president—these governors violated one of the fundamental tenets of state government that date back to the dawn of human greed: they refused FREE MONEY!

Now, in a paper published by the National Bureau of Economic Research, four scholars have illustrated the human price of this nonfeasance by Republican governors. According to the paper, somewhere around 15,000 Americans died between the years 2014 and 2017 as a result of states that turned down the FREE MONEY! available to them from the federal government through the provisions of the ACA.

Our analysis shows that the ACA Medicaid expansions reduced mortality among this targeted group. Prior to the expansions, individuals in our sample residing in expansion and non-expansion states had very similar trends in both Medicaid coverage and mortality. At the time of the expansion, the trajectories of these two groups diverged significantly, with expansion state residents seeing increases in Medicaid coverage and decreases in the probability of being uninsured, and decreases in annual mortality rates. In the first year following the coverage expansion, the probability of mortality declined by about 0.09 percentage points, or 6.4 percent relative to the sample mean. The estimated impact of the expansions increases over time, suggesting that prolonged exposure to Medicaid results in increasing health improvements...

Our analysis provides new evidence that Medicaid coverage reduces mortality rates among low-income adults. Our estimates suggest that approximately 15,600 deaths would have been averted had the ACA expansions been adopted nationwide as originally intended by the ACA.

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Further, the study says that the most significant health benefits available to the people in states where the governors accepted the FREE MONEY! came in the ability of those people to schedule regular visits to general practitioners and to access preventative care. As the report's conclusion says:

There is robust evidence that Medicaid increases the use of health care, including types of care that are well-established as efficacious such as prescription drugs and screening and early detection of cancers that are responsive to treatment. Given this, it may seem obvious that Medicaid would improve objective measures of health. However, due to data constraints, this relationship has been difficult to demonstrate empirically, leading to widespread skepticism that Medicaid has any salutary effect on health whatsoever. Our paper overcomes documented data challenges by taking advantage of large- scare federal survey data that has been linked to administrative records on mortality. Using these data, we show that the Medicaid expansions substantially reduced mortality rates among those who stood to benefit the most.

The original intent of the ACA was to have the Medicaid expansion applied nationwide. Strict constructionist textualist John Roberts carved a huge loophole in the law and Republican governors threw themselves through it, dragging sick people behind them. Some of those people died because of what they did.

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