Even a study expansion foes tout shows coverage saves lives

Photo: isafmedia/Creative Commons

Photo: isafmedia/Creative Commons

In arguing against Medicaid expansion, some foes have argued it wouldn’t help people without coverage.

That seems like a hard sell. It makes one wonder why anyone would want insurance if it doesn’t matter. And it runs counter to many studies showing that insurance coverage is related to lower rates of illness and deaths.

Now expansion foes are touting a study they say proves that insurance doesn’t matter

The Maine Wire, an on-line publication of the Maine Heritage Policy Center, is publicizing a 2009 report by Dr. Richard Kronick.

However, if you read Kronick’s full study, you find that the death rate for the uninsured is higher, under certain conditions.

Understanding this gets a bit technical. But it is really not that complicated. Basically, it comes down to how the groups that are compared are broken down.

Krosnick doesn’t just compare uninsured and uninsured people. And that’s actually the right approach.

How health status is treated makes all the difference.

The main model, the one the Maine Wire reports on, (using a statistical method called multivariate regression), lumps sick people with sick people and healthy people with healthy people. (The technical term for this is including health status as a covariate.)

Dividing people by health status leads to different results than when the study keeps sick and people together. (The technical description for keeping the healthy with the sick is excluding health status as a variable.)

When you look at just healthy people and compare ones with insurance and those without it, insurance coverage doesn’t make a big difference in mortality.

However, as Kronick reports (see below), if sick and healthy people are not separated before making the comparison, there is a 10% higher death rate for uninsured people. 

When self-reported health status is included as a covariate, there appears to be no difference in the survival probabilities of uninsured and similar insured persons. With health status excluded, the uninsured have a 10 percent higher mortality rate than similar insured persons. [source]

This difference in the statistical model, which seems so technical, has a huge effect on what the study found.

One way, there’s no difference in deaths. The other way, mortality is a whopping 10% higher for uninsured people.

Kronick acknowledges that, saying, “[T] the strength of the association between lack of insurance and mortality is highly dependent on the covariates included in the model—an alternate title for this paper might be ‘Lack of insurance and mortality: you get what you control for.'”

People without insurance have their illnesses discovered later. That has to be taken into account in evaluating what happens when people get covered.


By the waysome expansion opponents say that Medicaid isn’t a good approach and that it is inferior to private insurance.

Putting aside for now whether that’s true, it makes one wonder why they don’t then support expanding Medicaid the way our neighbor New Hampshire has chosen — by using Medicaid dollars to cover insurance premiums. The same approach is being used in Arkansas and certainly could be explored for the Pine Tree State. Yet Maine’s expansion proponents have shown no interest in this approach thus far.

Amy Fried

About Amy Fried

Amy Fried loves Maine's sense of community and the wonderful mix of culture and outdoor recreation. She loves politics in three ways: as an analytical political scientist, a devoted political junkie and a citizen who believes politics matters for people's lives. Fried is Professor of Political Science at the University of Maine. Her views do not reflect those of her employer or any group to which she belongs.