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Saturday, December 10, 2016

According to a report published Monday in the Annals of Internal Medicine, Massachusetts’ 2006 health care reform law — commonly known as Romneycare —  has been linked to a “significant decrease in all-cause mortality.” This new finding serves a political blow to the GOP, which is facing mounting evidence that the Affordable Care Act — which is largely based on the Massachusetts law — is not only economically viable, but also on the right track to save American lives.

The study compared the mortality rates of individuals in Massachusetts with those residing in other New England states of “similar demographics and economic conditions,” and found an “absolute decrease of 8.2 deaths per 100,000 adults,” or 2.9 percent. Moreover, “deaths from causes amenable to health care” decreased by an even wider margin of 4.5 percent, or 300 lives saved every year. Conversely, the areas in which Romneycare was not implemented saw no changes in their death rates. This would suggest that expanded access to health care provisions, which Romneycare and Obamacare make possible, is pivotal in keeping people healthy for longer.

Graph from Forbes

 

Researchers also found that the poor and previously uninsured saw the sharpest decline in deaths. Though the study does warn that the results observed in Massachusetts cannot necessarily be extrapolated to other states, the numbers make a strong case for the potential effectiveness of the national health care law. And while Romney’s health care system failed to effectively enroll many Massachusetts residents, Obamacare’s enrollment numbers continue to grow stronger. Last week, an official report from the Department of Health and Human Services confirmed Obama’s mid-April announcement that the program had passed the 8 million enrollment mark, and also provided demographic details about enrollees. According to the report, nearly 30 percent of enrollees fell in the prized 18-34 age group needed to keep costs in check.

The new figures also combat a 2013 study often cited by critics of Obamacare, who say that health care and insurance are not key factors in determining people’s health and longevity. That study, published in the New England Journal of Medicine, examined 10,000 Oregonians over the course of 18 months — some of whom received insurance expansion and some of whom did not — and determined that those with health insurance did not fare significantly better than those without it. However, the Massachusetts study is far more robust, as it closely followed  270,000 people over 4 years, and experts agree that having a larger population and longer time to observe results are necessary to find real changes in health outcomes.  

One of the most critical findings of the study was that conditions that were “amenable to health care,” like cancer, cardiovascular disease, infections, and other complications that are considerably less deadly if caught early and treated with better medical care, declined most among individuals with health insurance. This provides evidence that having health insurance is of paramount importance for preventing unnecessary fatalities. Without health insurance, many individuals opt out of treatment for diseases that are not immediately life-threatening but can lead to serious complications in the future, especially considering conditions like hypertension, diabetes, and certain kinds of cancer are linked.

On Monday, Massachusetts decided to do away with its “dysfunctional health insurance exchange” and instead merge with the federal enrollment site, HealthCare.gov. If the results of the Massachusetts health care expansion were applied on the national scale, saving 3 percent of lives every year, it would result in 17,000 fewer deaths. While the debate regarding the effectiveness of health care has raged for years, many experts are calling this latest study an important step forward in coming to a more conclusive answer, and it seems that the answer will be in favor of insurance expansion. As David O. Meltzer, a health economist from the University of Chicago, told The New York Times, “In the hierarchy of evidence, this ranks way above everything we’ve seen in the past in terms of the effects on mortality.”

Dr. Benjamin Sommers, the Harvard University School of Public Health assistant professor who led the study, agreed, saying, “It seems pretty clear that expanding insurance coverage will lead to gains in saving lives.” Obamacare’s Comparative Effectiveness Research (CER) component is also conducting its own experiment to examine the effects of expanding health care, and will be key in determining whether the Massachusetts results were state-specific. But until then, Jonathan Gruber, an MIT professor who worked on both the Massachusetts and national health care reforms, says, “We should basically be back to our presumption that health insurance improves health.”

Photo via Robyn Beck

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