Expanding U.S. state Medicaid programs may contribute to reduced death rates, as the poor, elderly and other vulnerable people benefit from greater access to health care, Harvard University researchers said in a report.

Three states that expanded Medicaid in 2001 and 2002, New York, Arizona and Maine, collectively saw a 6.1 percent decline in the death rate for people age 20 to 64 compared to neighboring states, according to the study published in the New England Journal of Medicine. Researchers at the Harvard School of Public Health, led by assistant professor Benjamin Sommers, found larger reductions among minorities and low-income people.

The findings from a decade ago suggest that governors who pursue a 2014 Medicaid expansion funded by the federal health- care overhaul may see a healthier population than those who don't, said Sommers, who took leave from Harvard last year to work as an adviser to the U.S. agency that oversees Medicaid. The Supreme Court said June 28 that the federal government can't force states to participate in the expansion.

"There may be significant benefits to access for care and health status for low-income adults" in states that expand Medicaid, Sommers, who plans to return to Harvard in September, said in a telephone interview. "It might even save lives." The Affordable Care Act, signed into law in 2010, seeks to extend Medicaid to people making as much as 1.3 times the national poverty level -- about $30,657 for a family of four this year. At least five Republican governors have said they won't participate in the expansion, citing increased costs and inadequate care compared to private insurance and Medicare, the federal insurance program for the elderly and disabled.

Opting Out "Medicaid has been poorly funded, poorly administered and often relegates the poor to bad quality medical care," Scott Gottlieb, a former deputy commissioner at the Food and Drug Administration who is now a researcher at the nonprofit American Enterprise Institute in Washington, said in an e-mail. "We owe the poor something better." Governors Rick Scott of Florida, Rick Perry of Texas, Phil Bryant of Mississippi, Bobby Jindal of Louisiana and Nikki Haley of South Carolina say their states can't afford to take part.

The federal government will pay all of the Medicaid bills for people added by the expansion until 2017, when states will then have to begin contributing. The U.S. will pay about $931 billion through 2022, and states would pay about $73 billion, according to the Center on Budget and Policy Priorities, a nonprofit research group in Washington.

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Safety Net The Harvard researchers analyzed data from the U.S. Census and the Centers for Disease Control and Prevention and zeroed in on three states that had expanded Medicaid to low-income adults without children to see what changes in mortality occurred.

Deaths among non-elderly adults increased during the same period in neighboring states that didn't expand Medicaid: Pennsylvania, New Mexico, Nevada and New Hampshire.

Sommers said that by pouring more money into Medicaid programs, states with expansions improved their "safety net" health systems such as public hospitals, which may have contributed to lower death rates.

Sommers, who works as an adviser at the U.S. Department of Health and Human Services, said his study was researched and drafted while he worked at Harvard and wasn't funded by the government.