(Roughly) Daily

As Angela J. Wyse and Bruce D. Meyer explain, lack of health insurance explains five to twenty percent of the mortality disparity between high- and low-income Americans…

We examine the causal effect of health insurance on mortality using the universe of low-income adults, a dataset of 37 million individuals identified by linking the 2010 Census to administrative tax data. Our methodology leverages state-level variation in the timing and adoption of Medicaid expansions under the Affordable Care Act (ACA) and earlier waivers and adheres to a preregistered analysis plan, a rarely used approach in observational studies in economics. We find that expansions increased Medicaid enrollment by 12 percentage points and reduced the mortality of the low-income adult population by 2.5 percent, suggesting a 21 percent reduction in the mortality hazard of new enrollees. Mortality reductions accrued not only to older age cohorts, but also to younger adults, who accounted for nearly half of life-years saved due to their longer remaining lifespans and large share of the low-income adult population. These expansions appear to be cost-effective, with direct budgetary costs of $5.4 million per life saved and $179,000 per life-year saved falling well below valuations commonly found in the literature. Our findings suggest that lack of health insurance explains about five to twenty percent of the mortality disparity between high- and low-income Americans. We contribute to a growing body of evidence that health insurance improves health and demonstrate that Medicaid’s life-saving effects extend across a broader swath of the low-income population than previously understood…

“Saved by Medicaid: New Evidence on Health Insurance and Mortality from the Universe of Low-Income Adults,” from @nber.org‬.

Congress, of course, just moved to cut Medicaid; as the wording in the “Big, Beautiful BIll” stands, 8-10 million Americans stand to have the their covergae terminated orr severely reduced.

But even as we agree that extending coverage– fixing the “demand side” problem– could save lives, we should note that we have some serious supply side problems to address: 80% of the country, insured or not, lacks adequate access to healthcare service; and there’s a large and growing shortage of healthcare professionals and workers (a problem aggravated by the Trump administration’s draconian crackdown on immigration). Technology offers some hope, but humans remain at the center of the issue.

* Ralph Waldo Emerson

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As we contemplate care, we might send insightful birthday greetings to Susan Lindquist; he was born on this date in 1949. A molecular biologist, she was a pioneer in the study of protein folding. She showed that alternate structural shapes of protein molecules could result in substantially different effects and demonstrated instances in fields as diverse as human diseases, evolution, and synthetic biomaterials designed to interact with biological systems. Her work laid the foundation for the development of AI-driven systems like Alpha-Fold that accelerate the discovery and development of new drugs and therapies.

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