The recent headlines abound. “Why McConnell’s New Health Care Rule Could Be a Death Sentence,” says Vanity Fair. Vox offered a concrete number. “208,500 additional deaths could occur by 2026 under the Senate health plan,” it states. A Washington Post article hedged, “The hard-to-answer question at the core of the health-care fight: How many more people might die?”
“This is an important policy point that’s become a rhetorical one,” the Post’s Philip Bump writes. “Sen. Bernie Sanders (I-Vt.) said that ‘thousands of people will die’ under the Republican bill; Sen. Orrin G. Hatch (R-Utah) replied with sarcastic nostalgia for the ‘brief time when we were *not* accusing those we disagree with of murder.’ Hillary Clinton called the GOP the ‘death party,’ and evoked a ferocious response.”
Amid these political arguments on both sides of the aisle, three recent studies draw upon data, rather than ideology, to suggest a tie between lack of coverage and negative health results.
“Arguing that health insurance coverage doesn’t improve health is simply inconsistent with the evidence,” write Benjamin Sommers, Atul Gawande, and Katherine Baicker in a recent New England Journal of Medicine article.
“Politicians have recently argued that the number of people with health insurance is not a useful policy metric, and that no one dies from a lack of access to health care,” researchers write, but assessing insurance’s impact is complicated, and it can take a long time for effects to appear.
As to whether repeal of the Affordable Care Act will impact health and mortality, the “body of evidence” that researchers studied indicates “coverage expansions significantly increase patients’ access to care and use of preventive care, primary care, chronic illness treatment, medications, and surgery,” they write. “These increases appear to produce significant, multifaceted, and nuanced benefits to health.”
In a recent study in Annals of Internal Medicine, Steffie Woolhandler and David Himmelstein found similar results. Their paper “strengthens confidence” in a 2002 Institute of Medicine review, which found that a lack of health insurance increases mortality rates. “Health insurance saves lives,” the authors of the 2017 study write. “The odds of dying among the insured relative to the uninsured is 0.71 to 0.97.”
In the recent study, the authors searched PubMed and Google Scholar for English articles that used some version of the terms “uninsured” and “mortality” (there were several permutations in the search parameters), and they then searched bibliographies of the relevant papers. They conclude that not only is the case that insurance saves lives strong, but “Even skeptics, who suggest that insurance doesn’t improve outcomes seem to vote differently with their feet.”
A third study, published in Cancer, found that “Medicaid disenrollment is associated with a later stage of disease at the time of breast cancer diagnosis,” which provides “evidence of the potential negative health impacts of Medicaid contractions.” So write Wafa Tarazi, Cathy Bradley, Harry Bear, David Harless, and Lindsay Sabik.
In particular, the study focused on the effects in Tennessee of disenrollment from Medicaid in 2005 on nonelderly, breast cancer patients. “Overall, nonelderly women in Tennessee were diagnosed at later stages of disease and experienced more delays in treatment in the period after disenrollment,” they write. They found a 3.3 percentage point increase in late stage disease associated with disenrollment.
“You may have noticed that there’s a bit of a debate going on about health insurance in this country. Reflecting the great diversity of American political life, we have those calling for a universal, single-payer healthcare system,” notes F. Perry Wilson in a MedPage video. He adds that several studies suggest that “insurance has a modest, but real, effect on all-cause mortality. Something to the tune of a 20 percent relative reduction in death compared to being uninsured.”
“It is hard to think that forcing people off the insurance rolls in this country can occur without some cost in terms of lives lost,” he adds.