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Insurance is a Lifeline for Americans

The value of insurance on mortality is not up for debate (Volume 10, Issue 14)

Throughout the recent debates surround health reform, the question about the value of health insurance continues to arise. Republican policy proposals would have left an estimated 20 to 24 million more people without insurance than under the Affordable Care Act leading many people opposed to the repeal bills to argue that repeal and replace would increase mortality.

Wendy Harman (Flickr/CC)

Pundits and politicians debated the validity of this talking point because to many people it sounds farcical that insurance would have an impact on mortality. To many people, insurance represents a financial and bureaucratic burden while hospitals and doctors actually save lives. However, due to the high cost of health services, access to potentially life saving care is often one of the first barriers to whether a person can remain healthy. Logic follows that removing the financial burden would allow more people to seek medical care and therefore would reduce mortality.

Now, as policy makers consider bipartisan fixes and members of the Democratic Party have been focused on single payer alternatives, the value of insurance and how it impacts mortality deserves a second examination. Woolhandler and Himmelstein – founders of Physicians for a National Health Program – look at the evidence in June’s Annals of Internal Medicine. What they find confirms that there is a strong connection between insurance and mortality.

In 2002, the Institute of Medicine (IOM) – using evidence from studies preformed up to the 1990s – found that insurance coverage is associated with a decrease in mortality.  The current study reviews  more recent articles comparing the insured and uninsured among non-elderly adults. Examining randomized control trials, population based health surveys, quasi-experimental studies, and international comparisons, the authors conclude that  “the odds of dying among the insured relative to the uninsured is 0.71 to 0.97.” This evidence strengthens the 15-year-old conclusions by the IOM that being uninsured is associated with increasing risk of death.

Insurance coverage is critical to decreasing preventable mortality. The question of whether removing the financial barrier to care reduces mortality cannot be debated by policy makers. While there are many other arguable points surrounding the value of insurance and how it affects costs and affordability, the value that insurance has on the difference between life and death has been answered.

This Policy Prescriptions® review is written by Emma Sandoe, MPH. Ms. Sandoe is a PhD candidate in Health Policy at Harvard University. She holds an MPH from George Washington University. Previously she was the spokeswoman for Medicaid and ACA policy analyst for HHS.


About 28 million Americans are currently uninsured, and millions more could lose coverage under policy reforms proposed in Congress. At the same time, a growing number of policy leaders have called for going beyond the Patient Protection and Affordable Care Act to a single-payer national health insurance system that would cover every American. These policy debates lend particular salience to studies evaluating the health effects of insurance coverage. In 2002, an Institute of Medicine review concluded that lack of insurance increases mortality, but several relevant studies have appeared since that time. This article summarizes current evidence concerning the relationship of insurance and mortality. The evidence strengthens confidence in the Institute of Medicine’s conclusion that health insurance saves lives: The odds of dying among the insured relative to the uninsured is 0.71 to 0.97.

PMID: 28655034

Woolhandler, S and Himmelstein, DU. Ann Int Med. 2017; 167 (6): 424-431.