Monday, January 22, 2018
Politics

PolitiFact Florida: Charlie Crist claims 6 die every day due to lack of health care

Former Florida Gov. Charlie Crist, now running for his old position as a Democrat, has attacked Republican Gov. Rick Scott for his tepid support for Medicaid expansion last year.

Scott said he would support it, but he didn't lobby for it, and ultimately the state Legislature rejected the expansion.

In a Feb. 7 interview on MSNBC's The Daily Rundown, Crist said that means "about 1 million of my fellow Floridians are not getting health care today, and I'm told by my friends at (the Service Employees International Union) that means that six people in Florida die as a result of that every day."

Is Crist's diagnosis correct?

The claim comes from a study released in late January on the blog of the health-policy journal Health Affairs. It was authored by researchers from Harvard University and the City University of New York.

The researchers looked at states that had opted out of Medicaid expansion, including Florida, where about 1.27 million people would have been eligible.

Researchers then used prior studies about the effects of expanding insurance to estimate the deaths for each state that didn't expand Medicaid.

In Florida, the study concluded, the number of deaths would range from 1,158 to 2,221. The only state with more projected deaths was Texas.

Crist arrived at his six-deaths-a-day figure for Florida by using the high end of the range cited in the study — 2,221 deaths divided by 365 days a year. If he had used the low-end figure, it would have worked out to three per day.

So what were the underlying studies?

• The Oregon Health Insurance Experiment, a comparison of about 6,000 patients who got a slot in a 2008 Medicaid expansion and about 6,000 who didn't. The study tracked factors such as blood pressure, cholesterol, blood sugar, depression, and out-of-pocket medical spending.

• A study by Harvard researchers Benjamin D. Sommers and Katherine Baicker compared three states that expanded Medicaid — New York, Maine and Arizona — with neighboring states that didn't expand it. This is what the Harvard/CUNY researchers used to calculate their high estimate of deaths and was published in the New England Journal of Medicine in 2012. The sample consisted of adults who were observed five years before and after the expansions, from 1997 through 2007.

• A study by Harvard researchers about health insurance and deaths. This produced the low-deaths estimate. The study was published in 2009 in the American Journal of Public Health; it followed individuals over 16 years.

The Harvard/CUNY study arrived at the death figures by looking at the number of individuals with depression, the number of patients on diabetic medications, the number of women who had a mammogram or pap smear in the past year and the number of people who had catastrophic medical expenses in the past year.

We interviewed two of the authors of the study, including Harvard professor Danny McCormick.

The lack of Medicaid expansion will mean that patients nationwide won't get certain diagnostic tests or take certain medications. "Cumulatively, that amounts to vast numbers of deaths," McCormick said.

Many experts told PolitiFact that denying Medicaid to poor Floridians will harm their health. But placing a precise figure as to how many will die per day, they added, is difficult.

"There is strong consensus in the public health community that this is a very harmful policy," said Harold Pollack, who told PolitiFact he is a "liberal health policy wonk" at the University of Chicago. However "the most difficult aspect of that policy to investigate is its effect on mortality."

Pollack said Crist is on solid ground to point out that the lack of Medicaid expansion causes serious harm. However, "I personally believe that these mortality estimates were on the high side of an inherently difficult calculation."

Some of the criticisms we heard focused on shortcomings of the underlying studies.

George Washington University professor Leighton Ku said that the Sommers/Baicker study looking at the mortality in a few states was "relatively rigorous" but warned that it came with caveats. The authors acknowledged that it may not be possible to generalize the findings to other states. Also the study states that it "cannot definitively show causality."

Crist said Florida's decision not to expand Medicaid means that "six people in Florida die as a result of that every day."

The statistic is based on a recent study, but experts note a few caveats. First, Crist used the study's high-end figure; using the low-end figure cuts the number of deaths to three a day.

Second, experts caution about uncertainties about the studies upon which the new study was based. And third, while many experts agree that it's plausible to assume that the lack of Medicaid coverage could lead to deaths, they were careful to add that it is difficult to pinpoint a number as precise as the one Crist offered.

We rate this claim Half True.

Edited for print. Read the full version at PolitiFact.com/Florida.

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