By Adam Gaffney, M.D., M.P.H.; David Himmelstein, M.D.; Steffie Woolhandler, M.D., M.P.H.
Health Affairs Blog, October 29, 2020
Findings of increasing uninsurance after 2016 accord with results of other governmental and non-governmental surveys. Most likely more than 2 million individuals lost health coverage during the first three years of the Trump administration. A further, more substantial increase in 2020 seems almost certain to occur. Projections based on unemployment data during the pandemic suggest that 5 to 7 million additional Americans will join the ranks of the uninsured this year.
Based on the ACS coverage data, we estimate that between 3,399 and 10,147 excess deaths among non-elderly US adults may have occurred over the 2017-2019 time period due to coverage losses during these years. Using the NHIS figures for coverage losses yields a higher estimate (between 8,434 and 25,180 non-elderly adult deaths attributable to coverage losses), while the CPS figures yield an estimate of 3,528-10,532 excess deaths among non-elderly adults. These figures do not completely capture the population effects of coverage loss, as they exclude the excess deaths that would likely result from coverage losses among children. In 2020 and beyond, we can project even more loss of life if, as expected, millions more lose health coverage due to the economic downturn associated with the pandemic.
Declining insurance coverage during the Trump administration has hence come at a heavy cost in physical and mental health, financial security, and loss of life. However, larger policy changes may lie ahead that could have even greater health impacts. In November, the Supreme Court will hear arguments in the case California v. Texas. If, as the Trump administration has urged, it entirely overturns the Affordable Care Act, 19.9 million individuals could lose health coverage. Based on the same approach as outlined above, we estimate that this coverage loss would lead to 22,892 – 68,345 excess deaths among nonelderly adults annually. The life and health ramifications of this case — and of November’s election — are enormous.
By Don McCanne, M.D.
The negative life and health ramifications of the health policies supported by the current administration are enormous. It is hoped that today’s election will result in a shift to adopting policies that will have a positive impact on the life and health of the people of our nation. Regardless, after the election we will have to exercise people power no matter who wins.
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