Face facts, GOP: Obamacare is a lifeline that's doing enormous good

My colleagues and I have been studying the effects of Medicaid and Obamacare, officially known as the Affordable Care Act, for several years. Two of our studies have been published in the past few weeks, just in time to offer some hard evidence that Congress should consider as it races toward votes that would make dramatic changes in health care.

The American Health Care Act passed by the House and pending in the Senate would, according to the non-partisan Congressional Budget Office, cause 23 million Americans to lose insurance by 2026. Opponents of the AHCA have argued that this would cost thousands of people their lives. Meanwhile, AHCA supporters have argued that Medicaid is ineffective, that Obamacare is broken, and that “nobody dies” from a lack of access to health care.

What are the facts? Our findings can provide a valuable counterbalance to political rhetoric.

The first study in the journal Health Affairs was a four-year survey that included more than 10,000 people in states that took different approaches to Obamacare’s optional expansion of Medicaid to people slightly over the poverty line: Kentucky, which expanded Medicaid in 2014; Arkansas, which used those federal dollars to buy poor adults private insurance from the Obamacare marketplaces; and Texas, which did not expand coverage to this group. What did we find?

Adults in the two expansion states experienced dramatic increases in insurance coverage compared with what was happening in Texas, and this new coverage made a real difference in their lives. Uninsured people who gained coverage experienced a 41 percentage-point increase in having a usual source of care, a $337 drop in annual out-of-pocket medical spending, higher rates of preventive health visits and a significant increase in how they rated their health status. These benefits were similar whether people gained Medicaid or private marketplace insurance.

Who benefited the most from the Obamacare coverage expansions? In our study, more than two-thirds of the low-income adults in Arkansas and Kentucky were white, and most had not attended college. Working-class white Americans have struggled in recent years with worsening health outcomes and economic challenges. Our study shows that the Affordable Care Act has produced major benefits for this group.

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Meanwhile, roughly 70% of people in our study had a chronic illness such as diabetes, cancer, depression or heart disease — the kinds of pre-existing conditions protected by Obamacare but are at risk under the Republican proposals. Among these adults, we found that Obamacare led to more consistent medical care for their chronic conditions, increased their ability to afford their medications, and improved their health.

Did they live longer? In the time frame we studied and with the number of people we surveyed, there was no way to know whether this expansion of coverage saved lives. Death is a relatively rare event. Statistically, this means we have to study many more people to know whether health insurance policies are affecting survival.

Fortunately, the other study published last month takes a different approach and does offer answers to this question. By examining state expansions in Medicaid that happened in the decade before Obamacare and using population-level information on deaths among millions of Americans, we can draw longer-term conclusions on the survival effect of insurance. The study found that Medicaid expansions lowered population death rates by 6%, with the biggest reductions for causes of death that are more treatable with timely medical care, such as cancer, HIV, heart disease and infections.

Mortality rates dropped the most in the counties with the biggest gains in health insurance, findings similar to previous research we conducted on Massachusetts’ 2006 health reform that was the model for the Affordable Care Act. Overall, the study concludes that for roughly every 300 people covered by expanded Medicaid, one death was prevented.

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No single study is definitive, but the growing number of research studies demonstrating the benefits of health insurance coverage in general, as well as Medicaid and the Affordable Care Act in particular, should not be ignored. Our research suggests that Obamacare has improved medical care and health for millions of Americans, including low-income adults, working-class whites, people with pre-existing conditions and many others. In part based on findings like these, major physician, nurse and hospital groups have all come out in opposition to the AHCA, which would undo much of this progress.

The fate of the AHCA remains unclear, and there is still time for evidence to shape the debate. Contrary to the political rhetoric, Medicaid is effective. Obamacare, while in need of repairs, is not broken. And lives are truly at stake if Congress acts to deprive millions of Americans of access to health care.

Benjamin Sommers, an associate professor of health policy and economics at the Harvard T.H. Chan School of Public Health, is a primary care physician at Brigham & Women’s Hospital in Boston. 

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