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A new study by researchers at the Harvard School of Public Health finds that fewer people die when states expand their Medicaid programs.

The study was published in The New England Journal of Medicine as states are deciding whether to expand their Medicaid programs under the Affordable Care Act. As part of its ruling last month on the act, the Supreme Court ruled that states do not have to expand Medicaid, as was required by the law.

Some critics of Medicaid expansion have said the program does not improve the health of recipients, and may even lead to worse health, according to The New York Times.

The new study looked at data from New York, Arizona and Maine, which had expanded their Medicaid programs in the last decade to cover low-income adults without children or disabilities. They evaluated death rates in those states five years before and after the expansions. They compared them with death rates in four neighboring states—Pennsylvania, Nevada, New Mexico and New Hampshire—that did not expand Medicaid.

The study found that Medicaid expansions in the three states were associated with a 6.1 percent reduction in death rates, compared with neighboring states that did not expand Medicaid. The researchers calculated this corresponds to 2,840 deaths prevented per year for each 500,000 adults gaining Medicaid coverage.

People added to Medicaid in the three states also reported better health, and were less likely to delay seeking medical care.

“The recent Supreme Court decision on the Affordable Care Act ruled that states could decide whether or not they wanted to participate in the health care law’s Medicaid expansion. Our study provides evidence suggesting that expanding Medicaid has a major positive effect on people’s health,” lead author Benjamin Sommers said in a news release.

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