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Study: 43,000 Americans Could Die Because Of Obamacare Repeal

Study: 43,000 Americans Could Die Because Of Obamacare Repeal

Reprinted with permission from AlterNet.

Remember death panels? It seems like only yesterday when rabid Tea Partiers tried to convince the public that under the Affordable Care Act, Grandma’s fate was in the hands of so-called death panels, a fictitious team of insurers and (probably devil-worshippers) Democrats who would determine the extent of coverage. Many of the most diehard proponents of this lie, who went on to benefit from the ACA, are about to meet the real death panelists—their names are Paul Ryan, Mitch McConnell, Tom Price, and Donald Trump, and according to two experts who have studied the impact of insurance coverage on death rates for 30 years, approximately 43,000 Americans are at risk of death if the ACA is repealed.

As researchers David Himmelstein and Steffie Woolhandler explain in the Washington Post Monday, “The story is in the data: The biggest and most definitive study of what happens to death rates when Medicaid coverage is expanded, published in the New England Journal of Medicine, found that for every 455 people who gained coverage across several states, one life was saved per year. Applying that figure to even a conservative estimate of 20 million losing coverage in the event of an ACA repeal yields an estimate of 43,956 deaths annually.”

The bare outlines of Trump’s policy agenda promise to eliminate minimum standards for insurance coverage, the same standards that now prevent insurance companies from denying coverage to Americans with pre-existing conditions. This impacts even those currently unaffected by the law: “Abolishing minimum coverage standards for insurance policies would leave insurers and employers free to cut coverage for preventive and reproduction-related care. Allowing interstate insurance sales probably would cause a race to the bottom, with skimpy plans that emanate from lightly regulated states becoming the norm.”

During the campaign, Trump promised to protect Medicare and Medicaid. That was great for rallies, but in 2017 there are also threats to block grant Medicaid, which would leave countless poor Americans at the mercy of state governments which, the researchers remind us, “have shown little concern for the health of the poor.”

Medicare wouldn’t fare much better:

A Medicare voucher program (with the value of the voucher tied to overall inflation rather than more rapid medical inflation) would worsen the coverage of millions of seniors, a problem that would be exacerbated by the proposed ban on full coverage under Medicare supplement policies. In other words, even if Republicans replace the ACA, the plans they’ve put on the table would have devastating consequences.

Senate Minority Leader Chuck Schumer wasn’t kidding when he called the Trump administration’s health care plan “a war on seniors.” It’s also a war on the poor, the sick and frankly, all Americans who aren’t billionaire members of Trump’s cabinet. We can’t take comfort in the uncertainty of what the second half of “repeal and replace” means.

Ilana Novick is an AlterNet contributing writer and production editor.

IMAGE: Flickr/TaxRebate.org.uk

How To Get Sicker, Die Sooner, And Pay More For It

How To Get Sicker, Die Sooner, And Pay More For It

It is painful that five years after passage of the Affordable Care Act, 19 states still have not taken advantage of its option to expand Medicaid. It becomes more so with each new report on the deeply flawed U.S. health system.

The latest, from the National Academy of Sciences, finds that rich people live about 13 years longer than poor people. The researchers note that consequently, rich people end up getting the lion’s share of Social Security benefits. Such inequity should be attacked at its root. At the very least, we could use available tools to help low-income people get health insurance.

The NAS report is far from the first to highlight problems in our approach and results. The Commonwealth Fund last year examined health systems in 11 western industrialized nations. For the fourth time in a decade, the United States system placed first in cost and last in what it delivers. Our system is less fair, less efficient, makes us less healthy and gives us shorter lives. All that for an average of $8,508 per person, way more than second-place Norway at $5,669. In case you were wondering, Britain’s socialized National Health Service was No. 1 at less than half the U.S. cost.

That information landed just as Allan Detsky published a New Yorker analysis of two 2013 reports on global health systems by the Organization for Economic Cooperation and Development and the National Institutes of Health. The study of the 34 OECD countries found an alarming trend: The United States ranked 20th for life expectancy at birth in 1990 and fell to 27th in 2010. On a measure combining level of health and length of life, we plunged from 14th to 26th.

The NIH report by the federal Institute of Medicine found that Americans fared worse than people in 16 “peer” countries in nine areas: infant mortality, injuries and homicides, teen pregnancy, HIV and AIDS, drug-related deaths, obesity and diabetes, heart disease, chronic lung disease, and disability. Why? The authors cite a larger uninsured population than peer countries, worse health habits, more poverty, and more neighborhoods designed to require automobiles.

We have gained a few new tools since some of those studies were done. Some, such as Michelle Obama’s “Let’s Move” initiative and money for electronic medical records in the stimulus law, are nudging us slowly in a better direction. Among the most significant advances are the ACA’s new marketplaces (where individuals can buy insurance regardless of their health status) and the law’s expansion of Medicaid (even though the Supreme Court transformed it into an option that states could take or leave).

The Medicaid expansion is designed for people who make too much to qualify for traditional Medicaid but too little to afford even subsidized private insurance plans. In states that have rejected the expansion, nearly 4 million people are stuck in an absurd coverage gap. That’s even though the federal government is footing the entire bill for the additional enrollees until 2016 and will pay at least 90 percent for them after that.

If we’re already spending a huge amount on health care, why should we sink more into it? It’s a good question — yet we might not have to spend more if we were spending more wisely. We could start by slashing our astonishing medical pricing. It costs more than eight times as much for an MRI here as in Switzerland, a typical example from a study of nine countries released last year by the International Federation of Health Plans. Just this month, The New York Times reported on a 62-year-old drug that went from $13.50 to $750 per tablet overnight.

How can we get a grip on costs? In part by getting a grip on politics. Medicare, overcoming “death panels” alarmism, recently announced it will reimburse doctors for discussing end-of-life choices with patients. That may lead to a decline in expensive, painful and futile treatments. Next, we should lift bans on research into gun violence, the better to reduce shootings and their public health costs.

Ideology is standing in the way on guns, as it is in the 19 states refusing so far to expand Medicaid. The struggles of purple-state Virginia have been among the most epic. Democratic Gov. Terry McAuliffe has been repeatedly thwarted by Republican lawmakers in his push to expand Medicaid. Last year, a disloyal Democratic lawmaker resigned and threw the state Senate into GOP hands. This year Democrats are trying to win back the chamber and, along with it, the slim chance of a Medicaid deal. In the meantime, some 350,000 Virginians are stranded in the coverage gap.

And this, dear readers, is how you get to be last place in the developed world.

Follow Jill Lawrence on Twitter @JillDLawrence. To find out more about Jill Lawrence and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate website at www.creators.com.

This is an updated and revised version of a column from June 19, 2014.

Photo: Taber Andrew Bain via Flickr

Ending Life On Your Terms

Ending Life On Your Terms

The low point of the Obamacare debate — and there was much probing of the floor — had to be the “death panel” charge. It was the creepiest in a volley of lies aimed at killing health care reform.

What was the fuss about? A proposal to pay doctors for time spent talking to patients about the kind of care they wanted in their last days. Such conversations would be entirely voluntary.

That was it. That was all. But “death panel” nonsense fueled so much hysteria that the end-of-life consultation benefit — and it is a benefit — was yanked out of the Affordable Care Act bill.

Fortunately, grownups are taking over. A new report for the Institute of Medicine, “Dying in America,” details the insanity that forces aggressive, often torturous, treatments on terminally ill patients who don’t want them — and at great expense besides.

Most Americans say they’d prefer to die at home, but the default in American medicine is to rush the gravely ill to the hospital. There, tubes are forced down throats and stopped hearts resuscitated with electric shocks.

“If you’re on a ventilator in an intensive care unit, you’re usually unable to die at home,” Dr. Edward Martin, head of the palliative care medicine program at Brown University, told me. “You’re likely to die in the hospital on the ventilator.”

That’s why you need to make your wishes clear in advance (even if you’re only 18). You might want every weapon in the medical arsenal thrown at sustaining your life. Or you might want to spend your final days peacefully at home or at a hospice facility, surrounded by loved ones.

An end-of-life talk with a doctor spells out the options. Patients can use it as a basis for filling out an advance care directive — a form listing which treatments they would want or not want. Of course, they may change their mind at any time. And in any case, as long as they can speak, the form is irrelevant.

The authors of “Dying in America” — doctors, insurers, clergy, lawyers, experts on aging, Republicans and Democrats — offer workarounds for the fringe politics that demonized advance care planning in the earlier health reforms. First off, they urge private insurers to cover end-of-life consultations, which many already do.

Several states offer this benefit for their Medicaid patients. The American Medical Association wants Medicare to follow suit.

The report calls on Congress to end the “perverse” financial incentives that rush fragile patients into invasive medical treatments they’d prefer to avoid. Better reimbursements for home health care is one suggestion.

Critics of end-of-life discussions argue the doctors would “push” patients to end their lives prematurely. Why would doctors do that? Where’s the financial incentive in losing a patient?

Meanwhile, there’s evidence that for some very ill people, a palliative approach may extend life longer than industrial-strength medicine. Palliative medicine seeks to prevent or reduce the symptoms of disease — such as pain, vomiting and impaired breathing — rather than seek a cure. For those expected to live six months or less, such care is often delivered by a hospice service, at home or in a facility.

Medical procedures come with risks that are especially high for those in rapidly deteriorating health. Thus, the risks may outweigh the possible benefits. In a study of terminal lung cancer patients, the group that chose hospice care actually lived three months longer than another subjected to hard chemotherapy.

Whenever you think that radical politics have totally tied up the country’s ability to fix the absurdities riddling our health care system, you find gratifying examples of Americans just going ahead and making the repairs. Thankfully, end-of-life planning is becoming a routine part of American health care.

Follow Froma Harrop on Twitter @FromaHarrop. She can be reached at fharrop@gmail.com. To find out more about Froma Harrop and read features by other Creators writers and cartoonists, visit the Creators Web page at www.creators.com.

Photo: Martin Wippel via Flickr

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Debunked: 5 GOP Obamacare Talking Points That Have Bitten The Dust

Debunked: 5 GOP Obamacare Talking Points That Have Bitten The Dust

Obama

The New York Times reported Wednesday that a large majority of people who signed up for Obamacare have paid their premiums on time. While these numbers vary based on the state and the type of plan, The Times says around 80 percent of those who signed up are paying, which is required for insurance coverage to start.

And, just like that, another Republican talking point about the Affordable Care Act has been debunked.

This idea that Obamacare beneficiaries would not pay their premiums, effectively dooming the young law, is in good company. A number of Republican talking points about Obamacare have bitten the dust recently. From the completely outlandish — death panels, government-funded abortions, etc. — to the notion that the Obama administration would never hit its enrollment target, they’ve ranged in viability, but have all nonetheless evaporated.

Here’s a look back at five anti-Obamacare talking points that have inevitably been disproved.

AFP Photo/Saul Loeb

No One Will Sign Up 

Ted Cruz Tea Party

The line was repeated ad nauseam by Republican detractors of the president. But — not surprisingly — saying it over and over didn’t make it come true.

There was the time House Speaker John Boehner (R-OH) said: “Above all, this report is a symbol of the failure of the president’s health care law… It is a rolling calamity that must be scrapped,” after the initial low enrollment numbers were released. Or when Senator Ted Cruz (R-TX) tweeted: “106,185 people enrolled in Obamacare. 108,713 attended the 2010 NBA All-Star Game in Cowboys Stadium. .”

At the end of March, the White House released enrollment numbers that exceeded its initial goal of seven million. By the end of the first open enrollment period, signups were skyrocketing, eventually closing at above eight million.

Still, this hasn’t stopped some conservative pundits from questioning the success of the law. Charles Krauthammer, for example, now subscribes to the conspiracy theory that the numbers were fabricated by the administration.

“These guys go six months without any idea what the numbers are, and all of a sudden it’s to a decimal point,” Krauthammer actually said on television.

AFP Photo/Andrew Burton

A Lack Of Young People Will Cause A ‘Death Spiral’ 

This one had all the ingredients of a good GOP talking point: plausibility, an appeal to business thinkers, and a snappy catchphrase like “death spiral.” But these elements didn’t make it a reality.

Obamacare’s death spiral would occur, conservatives posited, because the number of old and sick people who signed up for coverage would not be offset by young, healthy people also signing up through the exchanges, causing premiums to rise and the entire program to spiral down the drain. But, thanks to the way the law was written, the so-called death spiral was never likely. And now it’s clear that health premiums are on pace to increase at the same rate as they were prior to the law being passed.

Furthermore, the final enrollment numbers show that 28 percent of those who enrolled via the federal exchange were between the ages of 18 and 34. While this number of “young invincibles” fell short of the administration’s initial target, it should be more than sufficient to prevent the law from collapsing.

Millions Will Lose Their Health Insurance

Henry Waxman

This talking point, which perhaps reached its pinnacle when Newsmaxreported that 100 million people could lose insurance under Obamacare, was largely disproved by a paper prepared for Rep. Henry Waxman (D-CA), the ranking Democrat on the House Committee on Energy and Commerce.

The paper concluded that a grand total of 10,000 individuals, in just one state, would lose coverage and not have a viable option to replace their health care plan.

“The assertion that the law will cause five million individuals who currently have coverage in the individual market to go without coverage in 2014 is baseless,” the report read. “Of the reported 4.7 million people who receive cancellation notices, 2.35 million should have the option to renew their 2013 coverage. An additional 1.4 million should be eligible for tax credits through the marketplaces or Medicaid, which will provide them more comprehensive coverage at lower rates. Of the remaining individuals, only 10,000 individuals in 18 counties in a single state would be unable to access a catastrophic plan, and many of these individuals may sign up for coverage through their state exchange.”

Furthermore, under the new law, the uninsured rate in the United States has dropped, according to a recent Gallup poll. According to the poll, the April 2014 uninsured rate is down 1.6 percent from March and currently sits at 13.4 percent. That is also the lowest number Gallup has ever found since they began tracking the rate in 2008.

 Photo: Charlie Kaijo via Flickr


Death Panels 

This one, advanced by former Alaska governor Sarah Palin, was certainly a whopper. So much so, in fact, that it was granted the title of “Lie of the Year” by PolitFact in 2009.

The death panel idea originated from a provision in the initial Affordable Care Act that would allow Medicare to pay for doctors and patients to discuss living wills and end-of-life treatment. To Palin, this was tantamount to the government holding a death panel to decide whether or not senior citizens are allowed to live.

Palin’s campaign, while ridiculous, did have important political ramifications: In 2011, the Obama administration deleted all references to “end-of-life” care from the provision in the bill.

Premium Prices Will Soar 

Health Care Premium

The final talking point is somewhat connected to the previously discussed “death spiral,” but deserves its own recognition. This one, offered again and again by Republican pundits like Sean Hannity, holds that insurance premiums for businesses and individuals will rise at an exponential rate because of the health care overhaul. Double-digit increases in health care premiums were expected by the right. It was going to be a disaster, they assured.

Well, disaster averted.

According to the USA Today, insurance rates are slated to rise by about 7 percent next year — similar to the rise expected without the Affordable Care Act.

“The double-rate increases we’ve been hearing are probably exaggerated,” Dave Axene, a fellow with the Society of Actuaries, toldUSA Today. “That’s not what we’re seeing from the actuarial organizations — I guess we’re being a little bit more optimistic.”  

Image via The Kaiser Family Foundation

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