By Jason Poquette,
A new study recently published in a June 2017 edition of the respected Annals of Internal Medicine proves what appears to be obvious: health insurance saves lives. Surprisingly, such conclusions are not easily come by. But by comparing various studies done around the U.S. and carefully analyzing the data, the authors could confidently conclude they found a “large reduction in mortality associated with increased coverage.”
The timing of this study happens to coincide with the ongoing national debate concerning the repealing and replacement of the Affordable Care Act (ACA) with a supposedly improved version under President Trump. But according to the Congressional Budget Office (CBO) the Republican health care bill would result in about 22 million Americans losing coverage over the next 10 years. If true, this appears to be a step in the wrong direction.
According to Gov. Charlie Baker, the result would be 264,000 Massachusetts residents losing insurance with a resulting $8.2 billion in costs to our state. “Overall, our analysis indicates that the (Senate bill) would increasingly strain the state’s fiscal resources, result in greater numbers of individuals without insurance and destabilize the commercial insurance market,” he said.
Dr. Steffie Woolhandler, an internal medicine physician and expert on public health, stated that “thousands of people are already dying each year because the ACA has left 28 million uninsured. The Republican health reform bills would increase that death toll.”
Of course, the suggestion that the replacement version of the ACA would result in fewer people with coverage has not gone uncontested. Tom Price, the secretary of Health and Human Services, reminded people that the goal of the new plan is to ensure “that there are more individuals who are insured” and that the CBO conclusions “are not accurate.”
Regardless of whether the new plan results or greater or fewer individuals covered, the evidence that coverage does improve overall health outcomes seems well established. In a New England Journal of Medicine published on June 21, 2017, the authors admit that “assessing the impact of insurance coverage on health is complex.” Nevertheless, they say the studies seem to strongly suggest that coverage expansions help “people live longer lives” and “arguing that health insurance coverage doesn’t improve health is simply inconsistent with the evidence.”
As a pharmacist working in a hospital setting I can personally attest to the challenges faced by individuals who are uninsured or under-insured with respect to their prescription benefits. Patients who do not routinely fill their prescriptions for their asthma/COPD inhalers, diabetes injections or testing supplies, or cardiovascular treatments tend to fare worse and end up admitted or re-admitted to the hospital.
But I also need to remind our politicians and policy makers that not all insurance coverage is created equal. Having “coverage” does not necessarily equate with having affordable access to care and medicine. Excessive premiums, high deductibles and copays and coverage gaps all must be factored in when we talk about providing better care. Far too often even insured patients are rationing their medical treatments in order to make ends meet.
The outcry from some is that a national, single payer system is the only answer if our goal is 100% medical coverage. I’m not a politician and I don’t claim to have a simple solution. But I do know that universal coverage is not a guarantee of better coverage, and the fact is that there are both public and private ways to accomplish the goal of insuring more people.
There is an old saying that “everyone has a right to their own opinion, but not to their own facts.” And when it comes to insurance coverage, it seems the facts are clear enough: health insurance saves lives. So let’s work together to make it happen.