A Matter of Life and Death

The American Health Care Act, aka Trumpcare, will shorten lives for many in the service of cutting taxes for a few.

By Mark Paul and James K. Boyce | March 2017

An earlier version of this article appeared at Inside Sources.

Earlier this month Republicans in Congress introduced a bill to repeal and replace the Affordable Care Act. Since then, debate in Washington has centered on the costs of the Republicans’ plan. But while money will move around if this plan is passed, it is really about life and death.

The core of the Republican plan is an end to a tax on investment income, a tax which has been used for the past seven years to pay for health insurance for about 20 million Americans (one in twelve of us).

Nancy Pelosi and other leaders in the Democratic Party have been on message—Trumpcare “couldn’t be worse.” They’re concerned about how many Americans are going to be thrown off healthcare, and they seem equally concerned about what they see as “the biggest transfer of wealth from low-middle income people to wealthy people in our country.” Pelosi wants the Republicans to “show us the numbers.” But let’s be clear about two things: the cards are stacked so high against most low-income Americans that they don’t have any wealth to transfer in the first place, and the numbers we most need to be talking about here are how many lives will be lost.

No health insurance program—public or private—is perfect. But people who have health insurance are more likely to get the preventative care, screenings, and medical care they need.

The Affordable Care Act has lengthened tens of thousands of lives. Before the Act was signed into law, one in six Americans were uninsured. Now, only one person in eleven lacks insurance. With over 20 million people gaining insurance, we saw real-life impacts. The expansion of health insurance coverage directly translated into reduced morbidity and mortality for Americans. Fewer Americans are sick, fewer are dying, and millions more are getting the dignity and care they deserve.

The Republican health care bill would roll back these gains, leading many Americans to lose coverage. We don’t yet know exactly how many, but we are talking here about millions of people. The Congressional Budget Office estimates that this bill would cause 14 million Americans to lose health coverage in the coming year, and 24 million to lose it over the coming decade.

But just how many people will lose their lives—not only their coverage—due to the proposed changes? That's hard to estimate, but it’s going to be in the thousands, at least. Researchers at the Harvard School of Public Health studied mortality rate changes in Massachusetts after the rollout of the state's health insurance platform in 2006. They found that overall the death rate from treatable illnesses declined by 4.5%. The decline in death was even greater even in areas of the state where there were more low income people who didn’t have health insurance before health reform. Harold Pollack, a University of Chicago professor, estimates that the Affordable Care Act saves around 24,000 lives per year. Let that number sink in for a moment.

Many Americans say that they want a new and better system. In fact, 58% of respondents to a Gallup poll favor replacing the Affordable Care Act— if it’s replaced with “a federally funded healthcare program providing insurance for all Americans.” Senator Bernie Sanders proposed to do this, and it was wildly popular on the campaign trail. A Medicare-for-All program would save tens of thousands of lives by extending health insurance coverage to all Americans.

During the campaign, Donald Trump promised to repeal and replace Obamacare with something “terrific,” something that would cover “everybody.” This new proposal is opposite. In the service of cutting taxes for a few, it will shorten lives for many. America must reject it.

Mark Paul is a postdoctoral associate at the Samuel DuBois Cook Center on Social Equity at Duke University. James K. Boyce is a professor of economics at the University of Massachusetts-Amherst.

Did you find this article useful? Please consider supporting our work by donating or subscribing.

end of article