Conventional wisdom might tell you, The Affordable Care Act will save thousands of lives, as millions of uninsured persons* receive the coverage they lacked, and hence the care they need.
But although commentators make the assumption that the ACA will improve the health of the uninsured, the link between health insurance and health isn’t so clear.
According to one study, the uninsured have a mortality rate 40% higher than that of the insured. However, there are other differences between the insured and the uninsured besides their insurance status, including education, wealth, and other measures of socioeconomic status.
So how much does health insurance improve the health of the uninsured? The empirical literature sends a mixed message. On one hand is an important Medicaid study. Researchers compared three states that had expanded their Medicaid programs to include childless adults with neighboring states that were similar demographically but had not undertaken similar expansions of their Medicaid programs.
In the aggregate, the states with the expansions saw significant reductions in mortality rates compared to the neighboring states.
On the other hand is another important Medicaid study. After Oregon added a limited number of slots to its Medicaid program and assigned the new slots by lottery, it effectively created a randomized controlled study of the benefits of Medicaid coverage. When researchers analyzed data from the first two years of the expansion, they found that the coverage resulted in greater utilization of the healthcare system.
However, coverage did not lead to a reduction in levels of hypertension, high cholesterol or diabetes.
Compare this fact with the benefits of Direct Care. Dr. Brian, of Forrest’s Access Healthcare in North Carolina, explains:
“The data shows that for blood pressure control, diabetes control, and cholesterol goals we are in the top tier percentile in the US. It also shows that every quarter we continue to get better… Just to give you some tantalizing data — the national average for the percentage of patients controlled to their goal blood pressure is less than 50%. [In 2011] our practice had 85% of our patients Systolic Blood Pressure at goal.”
Also, in a separate nationwide Medicaid study of people age 50-61, researchers looked at the study subjects’ access to healthcare and their health outcomes for the next 18 years. As expected, insured individuals used more healthcare resources than did uninsured people.
However, there was no evidence that being insured lowered the risk of death 12-14 years into the study, and only mild evidence of a mortality benefit at 16-18 years.
It’s our belief that actual care, that’s readily available and actually affordable, will always trump providing “possible” coverage. For each of us as individuals, the likelihood of a catastrophe is not likely. Yet we, as individuals, or as a society, spend huge amounts of money for coverage that both protects us from this “possibility” and provides us our routine care. However, people don’t have complete control over where they go. In many cases, they don’t have access to actual prices of services rendered. In the longterm, this arising confusion turns people off, makes them go, “eh, whatever.”
It’s this bad attitude that makes preventable conditions like diabetes, heart disease and high cholesterol so pandemic, and so worrisome.
* This fact is debatable, too. Reports indicate that many of the sign ups were the result of people who were formerly insured by companies and forced to switch into private plans. The enrollees also included people whose original plans were cancelled for not meeting Obamacare standards.Tweet