国会正在辩论削减医疗补助，一项重要研究表明，它可以挽救生命

【中美创新时报2025 年 5 月 17 日编译讯】（记者温友平编译）根据迄今为止有关医疗补助计划的健康影响的最权威的研究，自 2010 年以来，医疗补助计划的扩展已挽救了超过 27,000 人的生命。《纽约时报》记者莎拉·克利夫和玛戈特·桑格-卡茨对此作了下述报道。

研究显示，在《平价医疗法案》扩大覆盖范围后获得医疗补助（Medicaid）的贫困成年人，在特定年份的死亡率比未参加者低21%。两位经济学家通过分析3700万美国人的联邦记录发现，死亡率不仅在年龄较大的参保者中下降，在20多岁和30多岁的人群中也下降——这个群体通常被认为医疗需求很少，在医疗补助扩展之前，他们获得资格的可能性要小得多。

本月，美国国家经济研究局（NBER）的一份工作报告公布了上述研究结果。与此同时，众议院共和党人正在起草一项可能大幅削减医疗补助（Medicaid）的计划。该项计划覆盖了7100万低收入或残疾美国人。负责监督该计划的众议院能源和商务委员会周三批准了一系列政策，国会预算办公室估计，这些政策将导致数百万人在未来几年失去医疗保障。

该研究的作者表示，发表时间纯属巧合——他们的研究已经进行了两年——但他们承认，研究结果与当前的预算讨论特别相关。

研究人员发现，平均而言，医疗补助计划（Medicaid）需要花费17.9万美元才能挽救一年的生命——这与宫颈癌筛查和白血病治疗等医疗干预措施的支出相当。这低于公共和私人在汽车安全检查或建筑物石棉清除等干预措施上的支出总和。

此前的研究显示，医疗补助计划（Medicaid）可以挽救生命，但规模较小，且主要基于老年人和高危人群的数据。这项新研究将税收、死亡和医疗补助计划登记记录关联起来，收集了几乎所有美国贫困人口的数据，使研究人员能够以更高的精度和确定性衡量医疗补助计划的效果。

未参与该研究的健康经济学家认为这项研究是迄今为止最令人信服的证据，证明医疗补助以及一般的健康保险可以挽救生命。

麻省理工学院卫生经济学家艾米·芬克尔斯坦 (Amy Finkelstein) 表示：“这是一项重要的科学贡献，有助于我们思考医疗补助计划的作用有多大。”她没有参与这项研究。

密歇根大学经济学家莎拉·米勒 (Sarah Miller) 研究了医疗补助计划对健康的影响，她表示，有关年轻参保者的新发现令她特别震惊，在挽救的 27,400 条生命中，年轻参保者占了 29%。

“其益处远比我们最初想象的要广泛得多，”米勒说。“从成本效益的角度来看，拯救25岁人比拯救61岁人获益更多，这并不是因为他们的生命价值更低，而是因为他们还能活很多年。” 这项研究中，20多岁和30多岁的人群几乎占了被拯救生命年限的一半。

虽然健康和医疗保险之间的关系看起来很简单——获得医疗服务应该会带来更好的健康结果——但很少有严谨的研究能够发现这种联系。

兰德公司自20世纪70年代起开展了一项为期15年的研究，考察了私人保险患者在使用医疗服务时，如果必须支付更高的共付额或免赔额，其医疗费用会如何变化。研究结束时，研究人员发现，支付更高费用的患者与未支付更高费用的患者之间，健康状况几乎没有差异。

芬克尔斯坦和其他研究人员研究了俄勒冈州在2008年举行的医疗补助（Medicaid）抽签登记时进行的一项自然实验（该州无力覆盖所有申请者）。研究显示，获得医疗补助的人在两年后​​心理健康状况有所改善，但身体状况没有统计学上显著的变化。

这两项研究都涉及相对较小的群体，因此很难衡量罕见医疗事件或死亡的差异。

几十年来，贫困的美国人一直是最有可能缺乏医疗保险的群体。低薪工作很少能提供负担得起的医疗保险，而且在医疗补助计划（Medicaid）的大部分历史中，除非怀孕、残疾或育有年幼子女，否则它都不覆盖低收入成年人。但这种情况在2014年开始改变，当时奥巴马医改向各州提供了慷慨的联邦资金，以扩大覆盖范围。自那时起，一系列研究开始建立医疗补助覆盖率与死亡率之间的联系。

尽管早期研究发现，参与医疗补助扩展计划的州的死亡率有所下降，但这些研究无法证明其中的因果关系。最近的研究发现，获得医疗补助的老年人或病情较重的成年人的死亡率有所下降，但该研究并未考察年轻参保者的健康福利。

另一项研究对没有保险的美国人和在《平价医疗法案》市场上购买了保险并被随机选中收到提醒信的人进行了比较，结果也发现购买保险的人死亡的可能性较小。

死亡率下降通常被用作衡量总体健康状况显著改善的指标。但研究死亡率通常需要极其庞大的数据集。

“死亡率是一种罕见的结果，和许多罕见的结果一样，你需要大量的数据来研究它，”达特茅斯学院的健康经济学家安吉拉·怀斯 (Angela Wyse) 说，她与芝加哥大学的经济学家布鲁斯·D·迈耶 (Bruce D. Meyer) 共同撰写了这项新研究。

本文最初发表于《纽约时报》。

题图：众议院议长迈克·约翰逊。罗德·兰基/美联社

附原英文报道：

As Congress debates cutting Medicaid, a major study shows it saves lives

By Sarah Kliff and Margot Sanger-Katz New York Times,Updated May 16, 2025, 5:35 p.m.

The expansion of Medicaid has saved more than 27,000 lives since 2010, according to the most definitive study yet on the program’s health effects.

Poor adults who gained Medicaid coverage after the Affordable Care Act expanded access were 21 percent less likely to die during a given year than those not enrolled, the research shows. By analyzing federal records on 37 million Americans, two economists found that deaths fell not only among older enrollees, but also among those in their 20s and 30s — a group often assumed to have few medical needs and who would have been far less likely to qualify for Medicaid before the expansion.

The findings were published this month in a National Bureau of Economic Research working paper as House Republicans were drafting a plan that could significantly cut Medicaid, which covers 71 million low-income or disabled Americans. The House Energy and Commerce Committee, which oversees the program, approved a suite of policies Wednesday that the Congressional Budget Office estimated would cause millions of people to lose their coverage in the years ahead.

The study’s authors said that the publication timing was coincidental — their research has been in progress for two years — but acknowledged that the findings were especially relevant to the current budget discussions.

The researchers found that, on average, it costs Medicaid $179,000 to save a year of life — similar to the amounts spent on health care interventions like cervical cancer screenings and leukemia treatment. It is less than the combined public and private spending on interventions like safety inspections for cars or the removal of asbestos from buildings.

Previous research showing that Medicaid can save lives was conducted on a much smaller scale and mostly reflected data on older, sicker populations. The new study involved linking tax, death, and Medicaid enrollment records to gather data about nearly every poor person in America, enabling the researchers to measure Medicaid’s effects with far greater precision and certainty.

Health economists not involved with the study described the work as the most convincing evidence to date that Medicaid — and health insurance in general — saves lives.

“It’s an important scientific contribution that helps us think about the magnitude of what Medicaid does,” said Amy Finkelstein, a health economist at the Massachusetts Institute of Technology who was not involved in the research.

Sarah Miller, a University of Michigan economist who has studied the health effects of Medicaid, said she was particularly struck by the new findings on younger enrollees, who accounted for 29 percent of the 27,400 lives saved.

“The benefits are a lot more widespread than we originally thought,” Miller said. “From a cost-benefit point of view, there is a lot more benefit of saving someone who is 25 than 61, not because their life is of lesser value, but because there are a lot more years left of life to live.” In the study, people in their 20s and 30s accounted for almost half of the life years saved.

While the relationship between health and health insurance may seem straightforward — access to medical care should lead to better health outcomes — few rigorous studies have been able to find such a connection.

A 15-year study by the Rand Corp., beginning the 1970s, looked at what happened when privately insured patients had to pay more for using medical care, in the form of higher copayments or deductibles. At the end of the study, the researchers found few health differences between patients who had faced higher costs and those who hadn’t.

Finkelstein and other researchers looked to the natural experiment that occurred when Oregon held a lottery for Medicaid enrollment in 2008 (the state could not afford to cover everyone who wanted it). The research showed some mental health improvements after two years among people who had gained Medicaid, but no statistically significant change in physical outcomes.

Both of those studies involved relatively small groups of people, making it hard to measure differences in rare medical events or deaths.

For decades, poor Americans have been the demographic most likely to lack health insurance. Low-wage jobs seldom offer affordable coverage, and for most of Medicaid’s history, it did not cover low-income adults unless they were pregnant, disabled, or had young children. But that started to change in 2014, when Obamacare offered states generous federal funding to expand coverage. Since then, a flurry of research has been establishing a link between Medicaid coverage and mortality.

Although early studies found that death rates fell in states participating in the Medicaid expansion, they could not demonstrate cause and effect. More recent research found a decline in deaths among older or sicker adults who had gained Medicaid, but it did not examine health benefits for younger enrollees.

Another study, comparing uninsured Americans with people who bought coverage on the Affordable Care Act marketplaces after being randomly selected to receive a reminder letter, also found that those who bought insurance were less likely to die.

A falling death rate is often used as a proxy for measuring major health improvements in general. But studying death rates usually requires an extremely large data set.

“Mortality is a rare outcome, and like so many rare outcomes, you need a lot of data to study it,” said Angela Wyse, a health economist at Dartmouth College and a co-author of the new study with Bruce D. Meyer, an economist at the University of Chicago.

This article originally appeared in The New York Times.