To those who control Florida health policy, discussions about Medicaid are exclusively about dollars and cents.

Gov. Rick Scott calls the health-insurance program for certain low-income groups a budget-buster, even though Florida has one of the lowest Medicaid costs per patient in the nation.

He refuses to consider the expansion of Medicaid to low-income adults who are uninsured, even though the federal government pays the whole tab until 2017 and at least 90 percent after that.

He speaks only of future costs, without looking at savings that could accrue to hospitals and without looking at economic benefits of a healthy, productive population.

Now, it's time to talk about human suffering and early deaths. A New England Journal of Medicine study published Thursday looked at death rates in three states that expanded Medicaid to the uncovered group a decade ago and compared them to mortality rates in neighboring states that did not.

We're accustomed to hearing about how lousy Medicaid coverage is, but it made a significant difference in mortality. For every 500,000 extra people covered, there were about 2,840 fewer deaths per year.

In the states that expanded Medicaid, the death rate went down. In the states that didn't, it went up.

Recently the Urban Institute estimated that almost 17 million of the uninsured will gain Medicaid coverage under the Affordable Care Act. Then the Congressional Budget Office calculated that if the states that are threatening to opt out do so, 6 million of those who would have been covered under Medicaid will not be. Maybe half of those can get coverage through the health exchanges, CBO figures.

In Florida, around one-fourth of the uninsured, the poorest 1 million, could be left out of coverage if Florida opts out of Medicaid expansion.

So let's do the math. If Medicaid expansion prevents 2,840 deaths/year for every 500,000, then Florida's looking at 2,840 times 2, or about 5,680 a year.

These are early deaths that are preventable.

So when the debate begins about Medicaid expansion, remind those who control the state that they aren't just talking about money. They're talking about lives.

--Health News Florida is an independent online publicatrion dedicated to journalism in the public interest. Contact Editor Carol Gentry at 727-410-3266 or by e-mail at [email protected]