On Tuesday, the liberal advocacy group Keystone Progress sent shock waves through the Pennsylvania’s capital with a mass email charging that Gov. Tom Corbett “killed four people” that day because he failed to embrace the Medicaid expansion in the Affordable Care Act.
The logic was that if Corbett had followed other states in accepting Medicaid expansion, it would have started Jan. 1, making people healthier and lowering death rates. Keystone Progress cited a Harvard study for the “four people a day” number — more on that shortly.
The message was savaged in a piece by John Micek, the respected opinion editor of the Harrisburg Patriot News who writes a widely read blog called Capitol Notebook. Micek noted that he disagrees with Corbett on many things, including Medicaid expansion, but that he’s a decent man who governs by his principles.
Micek noted in passing that Corbett has some endearing qualities and “gets downright goofy when he talks about his dogs.”
Keystone then doubled down by adding a new website, tomcorbettlovespuppies.com, which again asserts that four people die every day because the governor declined to expand Medicaid.
There are two issues to address here. First, Is the claim, however ghastly, accurate? Secondly, Is the language in the attack acceptable discourse?
Is it true?
I called Keystone Progress executive director Mike Morrill, and he explained that the group was just trying to get people to pay attention to a dramatic finding that was being ignored.
“We put out an email that highlighted the fact that a new study says that 1,491 people will die in Pennsylvania this year because we are not expanding Medicaid,” he said.
Well, actually, the study doesn’t say that. You can see the piece he cites here.
The study does say that expanding Medicaid will reduce mortality rates, and has a chart estimating how the death rate might diminish in Pennsylvania if Medicaid were expanded. There’s a “low” estimate of 398 and a “high” estimate of 1,491. Keystone Progress picked the high one because, well, it’s more dramatic.
Further, if you read the methodology of the higher estimate, you see it’s based on another study examining the effects of Medicaid expansion over several years. So even if the numbers are generally on target, you wouldn’t see a dramatic change in death rates the minute Medicaid expansion occurs. The effect would occur over time, as more people have insurance and get screenings and treatment that improve their health.
And since Medicaid expansion would have begun January first of this year in Pennsylvania had Corbett chosen that course, there’s just no way that we’d be seeing four deaths a day now. So, technically, the claim doesn’t hold up.
But is there an underlying truth that merits the incendiary language?
I asked Nicole Huberfeld, a University of Kentucky Law School professor and health policy analyst, if the research Keystone Progress cited is credible.
“I do think it’s credible,” she said. “It’s a projection of sorts. It recognizes there’s historical data that shows a correlation between consistent health insurance coverage and access to consistent medical care.”
So, yes, expanded health insurance will prevent some deaths.
What about calling Corbett a killer?
Huberfeld noted that Corbett is seeking a federal waiver for his own unique kind of health insurance expansion. And since he’s essentially holding the status quo for the moment in Pennsylvania health care rather than taking action to mitigate mortality rates, calling him a killer isn’t really justified.
“Does it foster debate about whether Pennsylvania should be moving in a different direction? It probably does,” Huberfeld said. “Sometimes there’s value in the shock factor. But since Pennsylvania is on a particular path right now, I’m not sure laying this at the governor’s feet is the most productive way to go about the debate.”
Morrill has no regrets about Keystone Progress’s language. Expanded health insurance really is a life or death matter, he argues, and it was time to get people’s attention.
“We did get the criticism we expected from some folks,” Morrill said. “But the reality also is that we had thousands and thousands of people who responded to that and wrote to Gov. Corbett and to their state legislators. We had hundreds of reporters who read our news release, which we never get. So we think it was very worthwhile doing it.”
Corbett’s spokesman Jay Pagni said the governor is always open to a policy debate, but that the language in the Keystone Progress attack was “reprehensible and disgusting.”