By Roger Stark
The nation continues to debate health care reform. The Affordable Care Act, or Obamacare, has provided health insurance for 20 million Americans, half of whom were placed in the expanded Medicaid entitlement. Yet the ACA has not accomplished its goals of providing universal health insurance and controlling the ever-rising cost of health care.
However, ACA supporters continue to argue that having health insurance saves lives. Former Senate Majority Leader Harry Reid, D-Nevada, said in 2009 that 45,000 Americans die each year because they don’t have health insurance. Sen. Bernie Sanders, I-Vermont, argues that 36,000 people will die each year if Obamacare is repealed. Other advocates are less specific, but claim that Americans will become “sick” again if the ACA is overturned.
Unquestionably, some people have been helped by being newly-insured. However, simply having health insurance does not guarantee timely access to medical treatment, while not having insurance does not predictably influence mortality rates.
Multiple studies have tried to show a relationship between higher mortality rates and being uninsured. One of the most famous was published by the Institute of Medicine in 2002 and concluded that being uninsured caused a 25 percent higher death rate than being insured. Subsequent research of the same patient group revealed that a respondent’s health status, such as obesity, and health behavior, such as smoking, fully accounted for the difference in mortality rates. Researchers found that insurance status had nothing to do with a person’s risk of dying.
A second often-quoted study came from Harvard University. It looked at mortality rates in three states that expanded Medicaid in the early 2000s. Only New York had a significant decrease in mortality, whereas Arizona and Maine saw no difference between insured and uninsured populations. The study was essentially inconclusive.
At least half of the newly-insured under the ACA nationally and 80 percent in Washington state were placed in the Medicaid entitlement. It is now well known that having Medicaid health insurance is no better for a person’s health outcomes than being uninsured.
In 2008, Oregon lawmakers decided they had enough additional public money to put more people into the state’s Medicaid program. Oregon officials held a lottery that ultimately signed up 6,400 new Medicaid enrollees. A further 5,800 people were eligible for the program, but were not selected. People in this group had the same health and economic profile as the lottery winners, allowing researchers to make valid comparisons. This created the perfect test-case on the effectiveness of Medicaid in providing care. These 5,800 people became the control group in an objective, randomized health care study.
The New England Journal of Medicine reported the results. The conclusion is revealing. It turns out that being put on Medicaid did not improve health outcomes nor improve mortality statistics, compared to having no insurance coverage at all. The Medicaid group had no improvement in the important objective health measurements of blood sugar levels, blood pressure and cholesterol levels. Abnormal levels of these parameters are definite precursors to cardiovascular disease, the most common killer in the U.S.
The insurance benefits in the ACA began in 2014. The mortality rate in the U.S. has actually gone up in the past two years. In 2015, states that expanded Medicaid under the ACA saw an increase in mortality of 9 deaths per 100,000. States that did not expand Medicaid experienced an increase in mortality of six deaths per 100,000. This is not a significant difference, but it does show that gaining Medicaid coverage had no effect on mortality.
The data is now very clear that having health insurance is not the same as obtaining timely access to medical care and to a decrease in mortality rates. The goal of health care reform should not simply be to give people insurance cards. Instead, reform should allow patients, as consumers of health care, the best opportunity to acquire the care they want and need. This will have a real impact on mortality rates.
Dr. Roger Stark is a retired cardiovascular thoracic surgeon and health care policy analyst for the Washington Policy Center.
Talk to us
> Give us your news tips.
> Send us a letter to the editor.
> More Herald contact information.
