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Lack of health insurance and U.S. mortality

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Lack of health insurance and U.S. mortality

PNHP co-founders Steffie Woolhandler, M.D., M.P.H., and David Himmelstein, M.D., have published a landmark review of studies in the Annals of Internal Medicine that points to a link between lack of health insurance and preventable deaths. Their review, “The Relationship of Health Insurance and Mortality: Is Lack of Insurance Deadly?” was published June 26, 2017, as the U.S. Senate considered a major health overhaul.

Although estimates range, there is a strong scientific consensus that uninsurance leads to tens of thousands of deaths annually. If any of the various GOP health bills become law, millions of Americans would lose coverage and the number of preventable deaths would increase dramatically. The “Better Care Reconciliation Act,” for example, would result in 22 million people losing coverage and an additional 29,000 deaths per year.

PNHP press release:
https://pnhp.org/news…

full review of studies:
http://annals.org…

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Sen. Sanders cites study findings on the floor of the Senate

In arguing against the “Better Care Reconciliation Act” on June 26, 2017, Sen. Sanders said, “The horrible and unspeakable truth is, that if this legislation were to pass, many thousands of our fellow Americans, every single year, will die, and many more will suffer and become much sicker than they should.” He submitted the Annals of Internal Medicine review, published earlier that day, to the Congressional Record.

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Families’ out-of-pocket medical costs fell after the Affordable Care Act, but not their premiums: Harvard researchers

New study is the first to estimate nationwide changes in household medical spending after the ACA, finds cost burden shifted slightly from poorer to richer Americans

FOR IMMEDIATE RELEASE: Monday, January 22, 2018 at 11:00 a.m. EST

Contact: Clare Fauke, clare@pnhp.org, 312-782-6006

Families’ out-of-pocket medical expenses decreased in the first two years after the Affordable Care Act was implemented, but their premium payments rose, according to a new study by researchers at Harvard Medical School and the City University of New York at Hunter College published today in JAMA Internal Medicine. The savings on annual out-of-pocket expenses averaged $74 (12 percent), with poorer individuals seeing the biggest drop (21.4 percent) while those with higher incomes saw no change. In contrast, higher-income households bore the brunt of premium increases (23 percent), while premiums for other income groups didn’t change significantly. Overall, households’ premiums rose by an average of $232 (or 12 percent). The findings indicate that the ACA shifted the spending burden from low- to higher-income households, and from out-of-pocket spending to spending on premiums.

The study analyzed national data on 83,431 non-elderly adults. The researchers compared households’ medical spending during the two years before and after the full implementation of the ACA in 2014. They assessed out-of-pocket outlays (any medical spending not covered by insurance) and premium contributions made by household members. In addition to analyzing how much families spent, the study examined “high-burden spending,” such as paying more than 10 percent of income (or 5 percent for low-income households) for out-of-pocket expenses. Premiums were considered “high-burden” if they exceeded 9.5 percent of income (the affordability threshold specified in the ACA).

High-burden out-of-pocket spending fell by 20 percent overall, with the most substantial decrease seen among poorer individuals. In contrast, middle-income households (those with incomes between 250-400 percent of poverty) saw a 28 percent increase in high-burden premium spending, while other income groups experienced little change in this measure.

“Our findings suggest that the Affordable Care Act reduced out-of-pocket costs for many Americans,” said the study’s lead author, Dr. Anna Goldman, a primary care doctor at Cambridge Health Alliance and fellow at Harvard Medical School. “But the ACA didn’t stem the steady rise in families’ premiums. Overall, the law helped ease families’ medical cost burden, but there is plenty of room for progress.”

“It’s not surprising that the ACA’s effects were modest,” continued Dr. Goldman. “Only 6.5 percent of Americans gained coverage through the ACA, while about 28 million remained uninsured. Moreover, efforts to make the ACA’s financing budget-neutral limited the generosity of subsidies and may have reduced the law’s potential to reduce medical spending.”

Dr. Steffie Woolhandler, a distinguished professor of public health at CUNY’s Hunter College and lecturer in medicine at Harvard Medical School noted: “The ACA helped smooth out spending, and made it more predictable. Fewer families were left with high out-of-pocket costs when they were sick, but paid more in upfront premiums. But the law fell far short of what many nations with single-payer systems have achieved: universal, comprehensive, and affordable coverage.”

“We’re worried that recent moves by the administration and Congress to undermine the ACA will erase the gains we observed, or worse,” said senior study author Dr. Danny McCormick, an associate professor of medicine at Harvard Medical School and primary care physician at Cambridge Health Alliance. “The repeal of the ACA mandate, weakening of insurance standards, and erosion of Medicaid will punish many lower-income Americans,” concluded Dr. McCormick.

“Out-of-Pocket Spending and Premium Contributions after Implementation of the Affordable Care Act” by Anna L. Goldman, M.D., M.P.A., Steffie Woolhandler, M.D., M.P.H., David U. Himmelstein, M.D., David H. Bor, M.D., and Danny McCormick, M.D., M.P.H., JAMA Internal Medicine, published online ahead of print January 22, 2018.

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Physicians for a National Health Program (www.pnhp.org) is a nonprofit research and education organization whose more than 22,000 members support single-payer national health insurance. PNHP had no role in funding or otherwise supporting the study described above.

Health care financing system deepens poverty and income inequality: New study

Researchers from Harvard University and Hunter College find that paying for health care pushed millions below the poverty level

FOR IMMEDIATE RELEASE: January 18, 2018
Contact: Clare Fauke, 312-782-6006, clare@pnhp.org

Researchers from Harvard University and Hunter College find that paying for health care pushed millions below the poverty level

Households’ payments for medical premiums, copayments and deductibles pushed more than 7 million Americans into poverty in 2014, according to a study appearing in the American Journal of Public Health. Such payments also dramatically worsened overall income inequality.

The researchers analyzed data on household medical payments from the Census Bureau’s 2010-2015 Current Population Survey, the standard source for estimating income and poverty.  First, the researchers calculated the number of people who were below the poverty level before taking into account their medical expenses. Then they compared that to the number whose income fell below the poverty level after subtracting payments for health insurance and out-of-pocket medical expenses.

After taking account of households’ medical payments, the incomes of the poorest 10% of the population fell by 47.6 percent. In addition, the burden of health care spending fell steadily as income rose. Such spending cut the incomes of households at the median income by about 8 percent, while it reduced the income of the wealthiest 1 percent by only 1.3 percent.

In their analysis, the researchers found that families’ health care spending markedly increased overall income inequality. Using economists’ standard measure of income inequality, the Gini index, they found that the index worsened by 1.37 points after taking account of health care expenditures. If employer-paid premiums were considered part of an employee’s compensation (a standard assumption in economics), the effect of medical payments on income inequality was even greater, a worsening of 1.70 points. These health spending impacts on incomes were equivalent to transferring between $149.6 billion (1.37 percent) and $185.6 billion (1.70 percent) from households with incomes below $75,738 to wealthier households in 2014.

The study also found that the Affordable Care Act slightly improved this pattern (by 0.10 points) even before considering the effects of its $22 billion increase in Medicare taxes on the top 2 percent of earners.

Dr. Steffie Woolhandler, a study author who is a distinguished professor of public health at the City University of New York at Hunter College (CUNY/Hunter) and lecturer in medicine at Harvard Medical School commented: “In many other countries, health care helps cushion the effects of poverty. But our health care financing system drives millions of Americans into poverty and worsens inequality. That’s not just a financial problem, it’s a medical one because poverty breeds ill-health.”

According to Dr. David Himmelstein, a distinguished professor at CUNY/Hunter and staff physician at Montefiore Medical Center in the Bronx: “In recent years, the gaps between rich and poor in both income and life expectancy have widened. Today, the richest Americans live 10 to 15 years longer than the poorest. A national health insurance program funded from progressive taxes instead of premiums and out-of-pocket payments would shift the financing burden to those who can afford it, and improve the health of our nation.”

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“The Effects of Household Medical Expenditures on Income Inequality in the United States”by Andrea Christopher, M.D., M.P.H., David U. Himmelstein, M.D., Steffie Woolhandler, M.D.,  M.P.H., and Danny McCormick, M.D. American Journal of Public Health, published online ahead of print January 18, 2018.

Physicians for a National Health Program (www.pnhp.org) is a nonprofit research and education organization whose more than 22,000 members support single-payer national health insurance. PNHP had no role in funding or otherwise supporting the study described above.

Health researchers: Graham-Cassidy bill would increase deaths by 41,600 annually

Doctors dub Graham-Cassidy “The Undertaker Full Employment Act”

FOR IMMEDIATE RELEASE, September 22, 2017
Contact: Clare Fauke, communications specialist, 312-782-6006, clare@pnhp.org

Physicians and public health researchers Drs. Steffie Woolhandler and David Himmelstein estimate that implementation of the proposed Graham-Cassidy legislation would push an additional 32 million Americans off their health insurance over the next decade, resulting in 41,600 additional deaths in 2027.

Since the Congressional Budget Office could not conduct a timely analysis of the bill before its expected vote, the researchers—who have studied the effects of insurance coverage on health outcomes—analyzed the bill’s impact on insurance coverage and mortality.

“The Graham-Cassidy bill—what we’re calling ‘The Undertaker Full Employment Act’—would cut health coverage by 14 million Americans in 2020, rising to at least 32 million in 2027,” said Dr. Woolhandler, an internist in the South Bronx, Distinguished Professor of Public Health at the City University of New York at Hunter College (CUNY) and lecturer in medicine at Harvard. “That means 18,200 extra deaths in the first year, climbing to 41,600 annually within a decade.”

Drs. Woolhandler and Himmelstein studied CBO projections of previous GOP “repeal and replace” bills, and then extrapolated how many individuals would lose coverage per $1 billion in health spending cuts in the Graham-Cassidy bill between 2020 and 2027.

From there, the researchers projected the number of associated deaths based on their recent study published in the Annals of Internal Medicine, “The Relationship of Health Insurance and Mortality: Is Lack of Insurance Deadly?” The study concludes that for every 769 people who lose health coverage, one person will suffer preventable death. Health insurance prevents deaths in part by improving the diagnosis and treatment of high blood pressure; uninsured and under-insured Americans with hypertension are known to be less likely to have their blood pressure under control. Lack of coverage also increases death rates in several other conditions, including breast cancer and major trauma.

“We became doctors to save lives,” said Carol Paris, M.D., president of Physicians for a National Health Program. “As physicians, we cannot be silent while Congress plays political games with the lives of our patients.”

The Graham-Cassidy bill eliminates insurance subsidies provided through the Affordable Care Act to about 8 million Americans, and makes substantial cuts to state Medicaid programs that today insure more than 70 million Americans. The bill also allows insurers to charge more for patients with pre-existing conditions who would likely be priced out of the insurance market altogether.

Dr. Paris notes that instead of cutting coverage to millions of Americans, Congress should cut the number of uninsured to zero through a universal, single-payer health plan like Rep. John Conyers’  H.R. 676, the Expanded and Improved Medicare for All Act or Sen. Bernie Sanders’ S. 1824, The Medicare for All Act of 2017.

Dr. Steffie Woolhandler is an internist in the South Bronx, Distinguished Professor of Public Health at the City University of New York at Hunter College (CUNY) and lecturer in medicine at Harvard. Dr. David Himmelstein is also an internist, Distinguished Professor at CUNY and lecturer at Harvard. They are co-founders of Physicians for a National Health Program (PNHP). Dr. Carol Paris is a retired psychiatrist and president of PNHP, a nonprofit research and educational organization of more than 21,000 doctors and health professionals who support a single-payer national health program. It was founded in 1986.