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Harold Pollack describes a new study in Death on the Installment Plan: Now we know: Rejecting the Medicaid expansion could kill nearly 6,000 people each year, that gives us a basis upon which to estimate the number of deaths that may be caused by those states that refuse to accept the federal funds to expand Medicaid that are included in the Affordable Care Act.

The study was published in the Annual of Internal Medicine on Monday which examined the impact of the "bipartisan insurance expansion enacted in Massachusetts in 2006 - a.k.a. "RomeyCare," which was the basic model for the A.C.A.. Three respected researchers, Benjamin Sommers, Sharon Long, and Katherine Baicker examined a decade worth of mortality data in Massachusetts, and other states, before and after passage of the health reforms.

They found Massachusetts' new insurance coverage reduced mortality rates by about 30 percent - that comes to one death per every 830 newly insured people per year.

Do these results generalize to the national expansion of coverage under the Affordable Care Act? Nobody really knows. Massachusetts has done a better and more enthusiastic job implementing RomneyCare than many states (and the federal government) have done thus far with ACA.

On the other hand, Massachusetts experienced the strongest survival benefits in low-income areas that contain many uninsured people. These counties look more like those in less-prosperous states most affected by health reform. Massachusetts began its reform as a prosperous liberal state with effective public health polices and a strong infrastructure of safety-net care. Other states are starting with a much less favorable baseline, and thus hold more dramatic possibilities for improvement. A state like Kentucky, which just provided coverage for the first time to hundreds of thousands of very poor people, might well see larger effects.

One thing is for sure. If anything close to these results apply, the ACA is saving many lives every year. The new law is projected to cover more than 20 million adults who would otherwise go uninsured. The Massachusetts estimates imply that the ACA will prevent something in the neighborhood of 24,096 deaths every year (simply: 20 million divided by 830). That’s more than twice the number of Americans killed in gun homicides. It’s considerably more than the number of Americans who die from HIV/AIDS.

Here's where his essay peters out a bit. We follow that the ACA is going to cover 20 million adults who would otherwise be uninsured, so dividing by 830 gives us 24,096 people per year saved by the ACA. Then the article just ends. So we are left to infer that the number of people who are not being covered by Medicaid expansion must be around 6,000 times 830?

I guess that is not to much to ask of readers, however, I would have been a lot happier if Pollack would have added one more sentence to nail down such a crucial conclusion that is not only the basis of his title but also one of the main political reason most of us want to read the story. We want to be iron clad on this because we intend to accuse these Governors of murdering this many people this year. It's generally considered good practice to nail down one's facts before accusing Governors of murder in public.

Intuitively we already know, or at least strongly suspect this general point, so trying to estimate the the number is primarily useful to the extent we can quote it to shame resistant G.O.P. Governors who are using their state's uninsured Medicaid populations as a political football.

We want to calculate the number of deaths per year in each state each Governor is responsible for and hang it around their necks like a dead albatross at every public event they go to. State media is not doing their job if they are not shouting questions like "how many Florida Medicaid non-recipients did you kill today, Governor Scott?"

And "Governor, do you have a message for the families of the "XXX" citizens of our state you killed this month by refusing free federal aid for Medicaid Expansion?"

So this is our next step for our health care policy wonks. In this regard, this looks like an tremendously useful and important study that Pollack should have added one more concluding paragraph to demonstrate how it is done.

No problem though we can do it.  We take the uninsured state Medicaid population divide by 830 and bingo! Then go make a paper machete albatross ... So we just need our own health care policy wonks here to take this finding of one death per 830 non covered and crank it through an excel spread sheet with each state's uncovered who would be eligible for ACA expanded Medicaid and we can head out to the state elections.  

9:45 AM PT: Gooserock asked us what our talking points should be:

Accepting federal Medicaid funds for our state means:

Saving x,xxx lives of __ citizen per year.
Bringing in x,xxx health care jobs to our state.
Lower health care premiums because we don't subsidize the uninsured.
Lower health care cost because hospitals don't subsidize the uninsured.
Healthier citizens = a healthier state
Fewer sick days = more profitable businesses
More $ in state = more profitable businesses

Get rid of stupid Republicans holding back success in our states!

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