Lack of insurance is tied to higher death rates, new study shows
As the Senate debates and amends its Obamacare replacement bill projected to leave 22 million without insurance, a new report found that those with insurance live longer than the uninsured.
The report, published Monday in the journal Annals of Internal Medicine, highlights the influence insurance can have on mortality as the Senate is expected to vote this week on the Republicans' Better Care Reconciliation Act. The Congressional Budget Office projected on Monday that 22 million people will lose insurance coverage under the proposed law by 2026.
"It's very important for the voters to know taking insurance from millions of people will result in increased death rates," said Dr. Steffie Woolhandler, co-author of the study and a professor of public health at the City University of New York at Hunter College.
Woolhandler and her co-author summarized the findings of multiple studies that compared mortality rates among those who are uninsured versus those who are not. There have been several studies over the past several decades that examine this question and most have concluded that those who are uninsured suffer from higher mortality rates compared with the insured.
Woolhandler said critics of such studies argue that there is too much uncertainty around how much of a difference there is in mortality rates between the uninsured and the insured. Indeed, some studies found mortality rates differed by less than 2% while others showed differences as high as 18%.
Despite the drastically different conclusions, Woolhandler said it's impossible to deny that insurance status does influence mortality.
However, some studies Woolhandler and her co-author analyzed found that there was no statistically significant difference in mortality rates between the insured and uninsured. That's likely because there are several challenges to accurately analyze the relationship between mortality and insurance status, the authors said. People sometimes change insurance status throughout their lives and ethical complications can arise in randomized trials that inquire about the uninsured.
Two studies the authors examined looked at the effects on mortality rates in Maine, New York and Arizona during the early 2000s shortly after Medicaid eligibility was expanded. The studies found that mortality rates in those states fell by about 6.1% compared to neighboring states in correlation to a 3.2 percentage-point decline in the uninsured rate. The mortality reductions were largest among minority populations in low-income counties.
Woolhandler said when uninsured individuals receive Medicaid coverage, a significant contributor to their improved health is better management of chronic diseases, particularly high blood pressure. The common condition can lead to health complications and contribute to increased mortality.
The Senate Republicans' Better Care Reconciliation Act would phase out federal payments for Medicaid expansion under the Affordable Care Act by 2023, likely prompting most of the 31 states that extended coverage for low-income adults to terminate the expansion.
Woolhandler said there is increasing evidence that insurance coverage is key to improved well-being and health. Individuals not only live longer lives if they are insured, but report feeling healthier, less depressed and more financially secure.
"We are achieving a scientific consensus that having insurance is good for your health," she said.
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