Insurance losses under proposed ACA replacement a matter of life and death

As the Republicans push forward their abysmal Affordable Care Act replacement, much of the talk surrounding its impact focuses on insurance numbers and premium hikes. Those things are certainly important. But this is more important: The Republican plan will cause unnecessary suffering and preventable death.

How do we know this? Let’s start with the Congressional Budget Office report that scored the Republican replacement plan, titled the American Health Care Act. That report estimates that if the Republican plan is enacted, 14 million more people would be uninsured by 2018 than would have been under the Obama-era ACA. Then, as the American Health Care Act’s longer-term provisions begin to take effect, CBO estimates that uninsurance number would climb to 21 million in 2020 and then to 24 million in 2026. That translates to 52 million Americans being uninsured by 2026. (To give you a clearer reference point: The latest figures from the U.S. Census, released last September, found that in 2015, 29 million Americans were uninsured. That’s down from 49.9 million uninsured in 2010, the same year Obama signed his health reform law. If the Republican plan passes, we will literally be erasing years of valuable progress.)

And here’s the crux of those numbers: not having insurance significantly increases a person’s risk of death and disease. For example, this 2009 study published in the American Journal of Public Health found that even after adjusting for all kinds of variables — such as income, education, smoking and exercise — people without insurance were more likely to die than people with health insurance. More specifically, the researchers found that lack of health insurance is associated with nearly 45,000 deaths each year in the U.S., which is higher than the number of deaths linked to kidney disease. Another study published in 2014 in Annals of Internal Medicine examined changes in mortality in Massachusetts after the state implemented its 2006 health reform law. That study found a “significant” decrease in all-cause mortality as well as a decrease in deaths due to reasons that can be addressed via health care.

But wait, there’s more. In a 2012 article in the New England of Journal of Medicine, researchers examined the mortality impact of the ACA’s Medicaid expansion. (The Republican plan phases out the Medicaid expansion and then reduces federal funding for the program. For more on that read Liz Borkowski’s Monday article.) That study found the Medicaid expansions were effective in reducing all-cause mortality by nearly 20 deaths per 100,000 adults, with such reductions greatest among older adults, people of color and residents living in low-income counties. For cancer patients, this 2013 study found that those without insurance and those with Medicaid coverage had a higher risk of death than patients with private insurance. On the topic on immunizations, researchers find that having insurance makes a big difference too. For instance, this 2015 study on adult immunizations found adults with insurance had much higher rates of being vaccinated against the flu, cancer-causing HPV, shingles, hepatitis A and B, and pneumococcal disease.

Of course, that’s all just the tip of the iceberg — there’s way more research out there on the impact of having health insurance. The point is that having health insurance — actually having that card in your hand, not just having access to having it — is truly a matter of life and death. It’s not a stretch to say that members of Congress truly have people's lives in their hands.

P.S. One talking point that I just absolutely have to comment on. President Trump and Republicans in Congress incessantly note that having the ability to sell health insurance across state lines will increase competition and lower costs. There is no federal law that prohibits this practice — none. This is a state issue, regulated by state officials. In fact, a provision in Obama’s Affordable Care Act says states can form interstate compacts that allow insurers to sell qualified health plans across state lines. Learn more about this bogus talking point here and here.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years.