Health Insurance Coverage, Mortality, and the Affordable Care Act

Introduction

The rising cost of health insurance coverage has hurt people who desperately need coverage but cannot afford it. Because many people choose insurance plans with high deductibles — since the premiums are much lower — they find it difficult to cover the out-of-pocket deductible when they are ill or injured, and as a result many do not report their medical or health problems to their providers. There are many other issues revolving around healthcare coverage, and this paper examines several of them.

Dr. Andrew Wilper and colleagues report that the United States "stands alone" among all industrialized countries in the fact that it does not provide health coverage for all its citizens (Wilper, 2009, p. 1). There are approximately 46 million Americans without health insurance coverage, Wilper explains. The most salient issue he addresses, however, is the relationship between being uninsured and mortality — in other words, how many people die in America each year because they lack health insurance?

Mortality Risk and the Uninsured

A study using data from roughly two decades ago found that 18,314 Americans between the ages of 25 and 64 die annually due to lack of health insurance (Wilper, p. 1). Wilper and colleagues then conducted their own study using more recent data. They drew on information gathered from the Third National Health and Nutrition Examination Survey, focusing specifically on the 9,005 participants between the ages of 17 and 64, in order to determine whether lack of insurance at the time of their interviews predicted subsequent death. Among those 9,005 uninsured individuals — after adjusting for factors such as leisure exercise, smoking, and alcohol use — 3.1% died, Wilper reports (p. 1). The conclusion: being uninsured is significantly associated with mortality.

Dr. Uwe Reinhardt, professor of Economics and Public Affairs at Princeton University, notes that the people without health insurance who are most at risk are the "low-income working stiffs" — those who are not poor enough to qualify for Medicaid but whose employers do not provide insurance and who cannot personally afford the "six to eight thousand dollars for a family of four" (Reinhardt, 2008, p. 1). For those who do receive employer-provided health insurance, Reinhardt explains that disaster strikes when they lose their job: "At the worst moment in your life, you also lose your insurance coverage... [and for] 50-year-olds, when their company gets bought out, restructured, they're on the street" (Reinhardt, p. 2). This scenario cannot occur in Canada, France, England, or Germany, since in those countries — unlike the United States — health insurance is tied to citizenship rather than employment.

Echoing Wilper's findings, Reinhardt notes that "uninsured people die earlier and die at a higher rate from the same illnesses simply because they go too late" for care (p. 4).

Economic Burden on Low-Income Workers and the Newly Jobless

In Gary Langer's ABC News article, he cites an ABC News/Washington Post poll showing that 62 percent of respondents would prefer a universal health insurance program over the current system in which employers may or may not provide coverage. At the time, "seventy-eight percent are dissatisfied with the cost of the nation's health care system," Langer writes (Langer, 2012, p. 1).

Some Americans who could afford health insurance delay obtaining it because it is either too expensive or requires a high deductible — which in turn causes serious financial hardship when a person is hurt or seriously ill. Langer's article reports that 23% of Americans say they — or someone in their family — have "put off medical treatment in the last year because of the cost" (p. 2). Notably, the same poll shows that eighty percent of those surveyed believe it is more important to provide health care coverage "for all Americans, even if it means raising taxes," than to hold down taxes and leave millions uninsured (p. 3).

There are many issues surrounding the Affordable Care Act (ACA), commonly referred to as "Obamacare." Among them is the requirement that by 2014, all Americans must carry health insurance or face a tax penalty. As of 2012, the U.S. Supreme Court was expected to rule on the constitutionality of the ACA in June of that year, and the uncertainty of that ruling left businesses in a difficult position. For example, then-GOP presidential candidate Mitt Romney made headlines on Tuesday, June 12, 2012, when he claimed that the health reform law was "hurting small business" (Rosenthal, 2012). Romney was responding to a report that an Iowa company, Nemschoff Chairs, was closing and relocating jobs to Wisconsin because of "Obamacare" (Rosenthal, p. 1). However, company spokesman Mark Schurman later clarified that the issue was not the reform bill itself but rather the "uncertainty as to what reform is going to look like" following the Supreme Court's ruling (Rosenthal, p. 1).

Conclusion

Rosenthal, Andrew. "Uncertainty and Health Insurance Reform." The New York Times. Retrieved June 14, 2012, from http://takingnote.blogs.nytimes.com.

Wilper, Andrew P., Woolhandler, Steffie, Lasser, Karen E., McCormick, Danny, Bor, David H., and Himmelstein, David U. "Health Insurance and Mortality in US Adults." American Journal of Public Health, 99(12), 1–7. 2009.