Proponents of the health reform law that became known as the Affordable Care Act (ACA) often argued that thousands of Americans were dying every year because of a lack of health insurance, and passing the proposed law would save thousands of lives every year. Opponents disputed those claims, and suggested that the law would not save lives, and would instead make people worse off and might even cost lives.
Now, new data from the Centers for Disease Control and Prevention shows that a U.S. life expectancy dropped in 2015 - a year after the major provisions of the ACA went into effect - and for the first time since 1993, when according to NPR, the drop was attributed to the AIDS epidemic, a flu outbreak, and an spike in homicide rates. While the relationship between health insurance and mortality might still be debated - and it is certainly too early to suggest, as NPR's analysis implies, that the ACA is as bad as the AIDS epidemic - one thing is clear: There is no evidence that the ACA is, on net, saving lives.
In 2009, during the run-up to the passage of a health care reform bill, Rep. Bill Pascrell (N-NJ) claimed on the House Floor that "as many as 22,000 Americans die each year because they don't have health insurance." A few months later, prior to the Senate vote on what became the Affordable Care Act (ACA), then-Majority Leader Harry Reid (D-NV) upped the ante, claiming that, "45,000 times this year - nearly 900 times every week, more than 120 times a day, on average every 10 minutes, without end - an American died as a direct result of not having health insurance."
Both of these claims were based on academic or think-tank studies, which had previously been called into question on methodological grounds by Richard Kronick, then an academic and former Clinton-administration official, who was serving in the Obama administration as a deputy assistant secretary of HHS at the time the ACA was passed. Kronick re-analyzed existing data and found that when controlling for initial health status, smoking status, and body mass index, there was no difference in mortality between those with employer-sponsored health insurance and those who were uninsured. This conclusion is buttressed by the finding, that expanding Medicaid to uninsured, low-income, non-elderly adults does not improve basic clinical measures of health status.
If a lack of health insurance was killing thousands of Americans every year, and the goal of the ACA was to save lives by reducing the percentage of Americans without health insurance, the clearest possible test of the success of the ACA would be a reduction in mortality. While there are some indications that the ACA did increase the percentage of Americans with health insurance, life expectancy has actually gone down, rather than up. Mortality - as measured by the age-adjusted death rate - increased 1.2%, rather than decreased due to more health insurance.
The decrease was small, and so far we have only one year of data for comparison. But one thing is clear - there is no evidence that the reforms of the ACA, not to mention the trillion-plus dollars spent on it, is saving lives.
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