We compared three states that substantially expanded adult Medicaid eligibility since 2000 (New York, Maine, and Arizona) with neighboring states without expansions. The sample consisted of adults between the ages of 20 and 64 years who were observed 5 years before and after the expansions, from 1997 through 2007. The primary outcome was all-cause county-level mortality among 68,012 year- and county-specific observations in the Compressed Mortality File of the Centers for Disease Control and Prevention. Secondary outcomes were rates of insurance coverage, delayed care because of costs, and self-reported health among 169,124 persons in the Current Population Survey and 192,148 persons in the Behavioral Risk Factor Surveillance System.
This comes from the description of methods of a recent article in the New England Journal of Medicine. The article was mentioned by the New York Times on July 26. I like the plots in Figure 1.
The Times provides some context as to why it is seen as “controversial” whether Medicaid expansions positively impact health outcomes:
Medicaid expansions are controversial, not just because they cost states money, but also because some critics, primarily conservatives, contend the program does not improve the health of recipients and may even be associated with worse health. Attempts to research that issue have encountered the vexing problem of how to compare people who sign up for Medicaid with those who are eligible but remain uninsured. People who choose to enroll may be sicker, or they may be healthier and simply be more motivated to see doctors.
See also earlier post.
Andrew Gelman picks apart the study behind a front page New York Times story. The story also got a link (and an uncritical link at that) on Freakonomics.
Gelman seems flabbergasted at what he sees as a hyperbolic claim resulting from a poor design filtered through poor journalism. I’m surprised at the surprise. As one commentator “Mark” points out at Gelman’s blog,
Andrew, this is my area of research (public health), and I don’t think you’re missing anything, and I’m not the least bit surprised that it resulted in big headlines in the NYT. This happens ALL THE TIME. Recall the recent results from Harvard regarding red meat and cancer: http://www.nytimes.com/2012/03/13/health/research/red-meat-linked-to-cancer-and-heart-disease.html?_r=1. OK, this one wasn’t exactly front page in NYT, but still they were hyping another similarly hopelessly flawed study. And, it’s not too hard to find many more examples in the NYT, some of which certainly made the front page. See John Iaonnidis.
Another commentator “Jonathan” suggests, “Anyone know of any studies that look at impacts of new studies on behavior changes. It would also be interesting the difference before and after the introduction of the internet. If that makes sense.” I second that–can we get data on gym memberships and match it to NYT circulation??