Better health, fewer deaths linked to Medicaid expansion


The theory guiding the Affordable Care Act’s call for expanding Medicaid to more low income and working-poor Americans is pretty simple: Getting them access to basic medical care will improve their lives and, in the long, run help control the overall cost of health care for millions of previously uninsured people.Mike King headshot 2

But measuring whether that theory works — beyond the anecdotal stories we’ve all heard — is exceedingly difficult, especially since the law is only a couple of years since being implemented.

The statistical evidence is beginning to come in, as illustrated here by this New York Times report about a study in the latest edition of JAMA Internal Medicine.

Looking at health surveys of people in neighboring states — one that expanded Medicaid and one that didn’t — researchers found that, in general, people who qualified for Medicaid in places where enrollment expanded reported better health than their demographically similar counterparts in states that have refused to expand the program. Moreover, those who got coverage reported two consecutive years of better health in follow up surveys.

Deeper dives into health care outcomes in years to come will be needed but this latest study is an indication that expanding Medicaid as the ACA envisioned it appears to be working. These same researchers using similar data points and surveys, two years ago calculated the predicted annual number of lives lost in states that refused to expand Medicaid.

In Georgia, that number is 1,170.

Let that sink in.

More than a thousand Georgians die every year because they don’t have insurance and can’t afford health care. If they lived in Ohio, or New Jersey or another state where Medicaid is available, they would be alive. Why is this not a public health priority?

By way of comparison, the Governor’s Office of Highway Safety wants Georgia to continue the note worthy trend of reducing the state’s annual death toll from traffic fatalities. The target for 2016 is 1,130. That’s a big challenge, given how crowded Georgia’s interstates and highways are.

It would be nice if we could get the number of Georgians who die because of lack of access to Medicaid down as well. That’s not so big a challenge. It’s pretty simple, actually.

Expand Medicaid. Save lives. Improve health.

Mike King is the Author of A Spirit of Charity: Restoring the Bond between America and Its Public Hospitals,” available through and the Seattle Book Co.

Read The New York Times review of the book:



By Arthur L. Caplan and Mike King

The first documented cases of local transmission of Zika infection in Florida illustrate the need for a coordinated and fully funded plan to deal with the public health threat Zika brings with it.

It’s one thing for the International Olympic Committee to ignore the clear and present danger of staging the Summer Games starting Friday in Rio. You can almost expect them to underplay the threat, given the financial investment of their member nations and the Brazilian government’s commitment to holding the games – Zika, raw sewage in the water, and bankruptcy be damned. But it is quite another for elected public officials in this country to walk away from their jobs with no funding and no real plan for what to do when – not if, but when – there is a Zika outbreak among pregnant women, threatening to deform and kill their babies.

It is too early for gloomy predictions of an epidemic in the mainland U.S. While Puerto Rico has been struck with a major outbreak it could be that other parts of the country will get lucky and dodge the Zika bullet.

But that’s the point. We already know enough about Zika to demand more action. We know that it can be spread by mosquitoes and is transmitted sexually by people who show no signs of illness or disease. We know it can get into the blood supply. We know that there is no vaccine or cure that mosquito control programs will help and that safe sex is a good idea. We know that all of us should take precautions while working or playing outdoors in areas where mosquitoes can breed.

And we also know this: That we need a sizeable infusion of federal and state dollars to carry all this out. Unfortunately, when Washington and the states can’t agree on how to engage a potential epidemic, history shows that that the burden of dealing with infectious disease outbreaks falls heavily on public hospitals, public health departments and local safety-net providers as it did 30 years ago with HIV/AIDS. Many of these providers are already overwhelmed dealing with poor and uninsured people with chronic conditions, like cancer, hypertension, heart disease and diabetes. Will the funding for programs these people depend on be set aside to deal with the more imminent threat of Zika? Should it be?

Florida officials have now confirmed more than a dozen cases of local transmission are located just north of downtown Miami. But weeks before that public health departments in South Florida had to scramble epidemiologists to investigate hundreds of potential cases, set up testing protocols to make sure no one is missed and gone door-to-door asking for urine samples. They have stepped up efforts at mosquito control in the region’s wetland-rich breeding vectors. Those efforts will be more important than ever – and more costly – now that it appears Zika-carrying mosquitoes have made their way into Florida’s tropical climate.

And if a locally widespread outbreak happens it will be South Florida’s largest public hospital, financially stressed Jackson Memorial in Miami, which will once again have to muster the expertise and financing to deal with a major public health threat.

Lest we calm our fears by wishful thinking that perhaps the transmissions will be contained to Miami, remember how wrong we were to think in the early 1980s that the first widespread cases of HIV among Haitian immigrants was mostly a South Florida problem. Keep in mind too that Miami is one of the biggest ports of entry into the U.S. from South American countries where Zika is widely circulating already. This includes returning visitors from Rio de Janeiro, which is expecting a half million tourists for the summer games. Brazilian health authorities have acknowledged more than 30,000 cases of Zika in the region around Rio.

The IOC ignored a plea by scientists and public health experts to postpone or move the games with what amounted to a claim that the event was too big to fail. But Congress lacks even that flimsy excuse for its failure to take timely action in this country. Despite President Barack Obama’s request for $1.9 billion in funding for Zika prevention and detection programs, Congress adjourned in July for seven weeks with no plan for how much the federal government is willing to spend.

Once again Republicans in Congress balked at more public funding for a public health emergency, preferring that the total appropriation be much less than what Obama sought. They insisted that whatever money was to be approved be offset by reductions elsewhere in the budget. This line of reasoning about zero-sum budgeting has gained popularity in recent years among the most zealous conservatives in Congress, even extending to special disaster assistance money going the Federal Emergency Management Agency after natural disasters. This crowd wants to hold the public health response from the Centers for Disease Control and Prevention and other federal health agencies to the same standard despite the fact that in outbreaks like Zika ands Ebola, speed matters and delays cost lives.

Even worse, when it appeared that a compromise on the funding level might be reached, conservative House Republicans attached deal-breakers to the measure – inserting language abolishing public funds for Planned Parenthood and some Obamacare programs – which Democrats correctly would not tolerate.

Unfortunately, holding important public health initiatives like Zika prevention hostage has become a standard tactic in a Congress that places a higher priority on ideological obstruction and zero-sum budgeting for anything but military spending. Zika unfortunately does not care about politics. Your children and grandchildren will pay the price for inaction.



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Arthur L. Caplan is director of the division of medical ethics at the NYU Langone Medical Center. Mike King is a journalist and author of the recently released book, A Spirit of Charity: Restoring the Bond between America and Its Public Hospitals.