No, Repealing Obamacare Won't Kill People (And It Hasn't Saved Lives Either)

Posted: Mar 14, 2017 12:50 PM

Yesterday, Katie wrote about the CBO projections on the Republican health care bill that aims to replace Obamacare. While it cuts the deficit by $337 billion over the next ten years, premiums will continue to go up and over 20 million would remain without health insurance by 2020 (with 14 million projected to lose their coverage). That figure is the one the Left is going to hammer home on the airwaves. The narrative has already been microwaved: this GOP replacement bill will kill people. Yet, has Obamacare saved lives? No. And repealing the bill wouldn’t kill anyone either. Most of the new enrollees through the Affordable Care Act came from Medicaid expansion. That’s not necessarily a beacon for better care. The Manhattan Institute’s analysis noted how President Obama’s health care overhaul hasn’t saved a single life. Moreover, states that expanded Medicaid, a core provision of Obamacare, fared worse in terms of mortality rates [emphasis mine]:

The ACA has had positive effects for specific individuals who have gained access to health care that they may not have had under previous law. By dramatically increasing government spending on health care, it also has relieved financial pressure on beneficiaries of that spending. One might further argue that the promise of coverage has valuable emotional or psychological effects. But defenders of the law make a much stronger claim: that the expansion of health-insurance coverage under the ACA has broad public health benefits and is saving thousands of lives—lives that will be lost in the event of repeal. This is not true.

To support this claim, ACA champions point to studies showing a statistical relationship between health-insurance coverage and declines in mortality. Two studies, in particular, have received significant attention: a 2009 study in the American Journal of Public Health4 that found “[l]ack of health insurance is associated with as many as 44,789 deaths per year in the United States”; and a 2014 study in the Annals of Internal Medicine5 that found “for approximately every 830 adults who gained insurance, there was 1 fewer death per year.”

But these studies focus on private, not public, insurance coverage. The AJPH study explicitly excludes Medicaid recipients from its analysis.6 The AIM study examines the effects of the Massachusetts health-care reform in 2006, which primarily expanded private insurance coverage.7 Thus, both studies suggest that a policy whose effect is to increase private insurance coverage could have substantial public health benefits. The ACA is not that policy.


If the ACA were, in fact, saving thousands of lives each year, that effect should appear in the nation’s public health data—in particular, in the measures of age-adjusted mortality and life expectancy. But something strange has happened in the past several years during ACA implementation: mortality stopped improving. In 2015, for the first time in decades, American life expectancy decreased.

According to the Centers for Disease Control (CDC), 732 out of every 100,000 Americans died in 201320 after adjusting for the changing demographic composition of the country.21 That figure fell in 2014—as it had fallen in 19 of the prior 20 years—to 725 out of every 100,000. But in 2015, the figure jumped back up to 733; only the second such increase in more than 20 years and the first to erase the prior year’s gains.22 This represented 30,000 more deaths in 2015 than had the mortality rate remained at the 2014 level; 80,000 more than had it fallen during 2014 and 2015 at the average annual rate of 10.5 per 100,000 seen during 2000–2013.

Perhaps some other phenomenon was responsible for the rise in mortality rates, and so, compared with what might have happened, the ACA improved matters. But this does not appear to be the case. Thanks to the split between states that did and did not choose to expand Medicaid under the ACA, a natural control group exists.23 Did states that embraced the ACA’s Medicaid expansion at least fare better than those that rejected it in this environment of rising mortality? No. In fact, they fared worse: states that expanded Medicaid in 2014 saw mortality increase by nine per 100,000 in 2015 while non-expansion states saw an increase of six per 100,000.

Granted, health care policy wonk Avik Roy wrote about the "humanitarian catastrophe" that is Medicaid. In short, a UVA study from 2011 showed that those who are uninsured fared better than people who are enrolled in this government program:

Despite all of these adjustments, surgical patients on Medicaid were nearly twice as likely to die before leaving the hospital than those with private insurance.

Patients on Medicare were 45% more likely to die than those with private insurance; the uninsured were 74% more likely; and Medicaid patients 93% more likely. That is to say, despite the fact that we will soon spend more than $500 billion a year on Medicaid, Medicaid beneficiaries, on average, fared worse than those with no insurance at all.

So, as you can see, there really is nothing to the narrative that will be unleashed upon us insisting that repealing Obamacare will kill people. It also hasn’t really improved care to begin with either.