WEIGH FACTS BEFORE YOU GUT ACA
My research shows Obamacare is a lifeline that’s doing enormous good
My colleagues and I have been researching the effects of Medicaid and Obamacare, officially known as the Affordable Care Act, for several years. Two of our studies have been published in the past few weeks, just in time to offer some hard evidence that Congress should consider as it races toward votes that would make dramatic changes in health care.
The American Health Care Act passed by the House and pending in the Senate would, according to the non-partisan Congressional Budget Office, cause 23 million Americans to lose insurance by 2026. Opponents of the AHCA argue that this would cost thousands of people their lives. AHCA supporters say Medicaid is ineffective, Obamacare is broken, and “nobody dies” from a lack of access to health care.
What are the facts? Our findings can provide a valuable counterbalance to political rhetoric. The first study in the journal
Health Affairs was a four-year survey that included more than 10,000 people in states that took different approaches to Obamacare’s optional expansion of Medicaid to people slightly over the poverty line: Kentucky, which expanded Medicaid in 2014; Arkansas, which used those federal dollars to buy poor adults private insurance from the Obamacare marketplaces; and Texas, which did not expand coverage to this group. What did we find? WORKING-CLASS GAINS Adults in the two expansion states experienced dramatic increases in insurance coverage compared with what was happening in Texas. This new coverage made a real difference in their lives.
Uninsured people who gained coverage experienced a 41 percentage point increase in having a usual source of care, a $337 drop in annual out-of-pocket medical spending, higher rates of preventive health visits and a significant increase in how they rated their health status.
These benefits were similar whether people gained Medicaid or private marketplace insurance.
Who benefited the most from the Obamacare coverage expansions? In our study, more than two-thirds of the low-income adults in Arkansas and Kentucky were white, and most had not attended college.
Working-class white Americans have struggled with worsening health outcomes and economic challenges. Our study shows that the Affordable Care Act has produced major benefits for this group.
Meanwhile, roughly 70% of people in our study had a chronic illness such as diabetes, cancer, depression or heart disease — the kinds of pre-existing conditions protected by Obamacare but that are at risk under the Republican proposals. Among these adults, we found that Obamacare led to more consistent medical care, increased ability to afford medications and improved health.
Did they live longer because of the coverage expansion? In the time frame we studied and with the number of people we surveyed, there was no way to know. Death is a relatively rare event. Statistically, this means we have to study many more people. DEATHS PREVENTED Fortunately, the other study looked at deaths among millions of Americans and does offer answers to this question. It found that state Medicaid expansions in the decade before Obamacare lowered population death rates by 6%.
The biggest reductions were for causes of death that are more treatable with timely medical care, such as cancer, HIV, heart disease and infections.
Mortality rates dropped the most in the counties with the big- gest gains in health insurance, findings similar to previous research we conducted on the 2006 Massachusetts health reform that was the model for the Affordable Care Act.
Overall, the study concludes that for roughly every 300 people covered by expanded Medicaid, one death was prevented.
The growing number of studies demonstrating the benefits of health insurance coverage, Medicaid and the Affordable Care Act should not be ignored. Our research suggests that the ACA has improved medical care and health for millions, including lowincome adults, working-class whites, people with pre-existing conditions and many others. In part based on findings like these, major physician, nurse and hospital groups are all opposed to the GOP bill, which would undo much of this progress.
There is still time for evidence to shape the debate. Contrary to the political rhetoric, Medicaid is effective. Obamacare, while in need of repairs, is not broken. And lives are truly at stake if Congress deprives millions of Americans of access to health care.