To use the Massachusetts study as evidence that a Medicaid expansion will reduce mortality, one must credit Medicaid increases in 2009–10 for mortality declines in 2007–08. That seems . . . unlikely. So the 'solid estimates firmly rooted in scientific evidence' rely entirely on one author’s study of four states, of which only New York appears to show that expanding Medicaid reduces mortality. Every other attempt to establish that conclusion has failed, and most point squarely against it.
But thanks to the roughly half of states that refused the ACA’s Medicaid expansion, a good control group exists. Surely the states that expanded Medicaid should at least perform better in this environment of rising mortality? Nope. Mortality in 2015 rose more than 50 percent faster in the 26 states (and Washington, D.C.) that expanded Medicaid during 2014 than in the 24 states that did not. Further, while two years is not enough time to evaluate a policy’s full effects, that is exactly the period over which the Massachusetts study found substantial mortality gains. Two years of gains from a different policy implemented by a single state a decade earlier can hardly be proof that the ACA saves lives when the ACA’s own two-year track record tells the opposite story.
The best statistical estimate for the number of lives saved each year by the Affordable Care Act (ACA) is zero. Certainly, there are individuals who have benefited from various of its provisions. But attempts to claim broader effects on public health or thousands of lives saved rely upon extrapolation from past studies that focus on the value of private health insurance. The ACA, however, has expanded coverage through Medicaid, a public program that, according to several studies, has failed to improve health outcomes for recipients. In fact, public health trends since the implementation of the ACA have worsened, with 80,000 more deaths in 2015 than had mortality continued declining during 2014–15 at the rate achieved during 2000–2013.
The 'long-term, holistic' studies that Carroll prefers show coverage for expectant mothers produced better health outcomes in their children and that children themselves receiving coverage had better health, educational, and financial outcomes. That's all great news, but there's one problem: Obamacare's Medicaid expansion does not target pregnant women or children.
He makes the same argument about drug companies, noting that they gladly sell their products in price-controlled markets overseas: 'those regulated profit margins outside the U.S. remain high enough that Grifols, Baxter and other drug companies still aggressively sell their products there.? Apparently he missed the day in Economics 101 that reviewed the difference between average and marginal cost. Seriously, there is typically a day dedicated to the topic because it is a hard one; a lot of students intuitively make the same mistake Brill does.