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Obamacare Saves One Life Every Day

Large gains in preventable mortality could continue as insurance coverage expands (Volume 10, Issue 28)

Prior to 2010, individuals age 19 to 25 had one of the highest uninsured rates in the United States. Approximately 30% of those in this age group were uninsured, compared to 16% of all Americans, on average. The Dependent Care Coverage provision of the ACA allowed this group to be covered by their parents’ existing health insurance plans. According to Census Bureau data, 6.6 million individuals that otherwise would not have been covered were able to gain insurance or remain insured as a result of this provision.

Alan Turkus (Flickr/CC)

A recent study sought to assess the impact of the ACA’s dependent care coverage expansion on young adult mortality rates. When compared to a natural control group of individuals aged 26-30,  the Dependent Care provision was associated with a 6.1% decline in disease-related deaths – approximately 30 fewer deaths per month or 357 per year. It is likely that the young adult population that received coverage under this provision was, in general, sicker than the young adult population as a whole due to various factors such as preexisting condition exclusions. This suggests that with insurance, individuals are now going to the doctor more and getting treatment for conditions before they become fatal.

Additionally, the study focused on disease-related mortality as these causes are most amenable to improved access to health care. Deaths due to trauma were not sensitive to health insurance expansion, given that EMTALA requires emergency treatment regardless of insurance. Unchanged trauma-related death provide a strong indication that the ACA’s health insurance expansion drove the reduction in disease-related deaths and not just a general change in overall health care trends.

The study results are consistent with the expected cumulative effect of health care on mortality as chronic diseases become better managed. With higher coverage rates, evidence of greater care utilization, and better self-reported health, the Dependent Care Coverage expansion has achieved significant gains in health. However, to fully assess the success of the ACA’s insurance expansion, policymakers need to know if further increasing insurance coverage will continue to lead to lower mortality rates.

This Policy Prescriptions® review is written by Jennifer N. Kistama, ML, MSN, RN. She is the Clinical Project Manager for the Oncology Care Model, an alternative payment model, at NewYork-Presbyterian Hospital/Weill Cornell Medicine and formerly a Neonatal Intensive Care nurse.

Abstract

BACKGROUND: In September 2010, the Affordable Care Act (ACA) enabled young adults to gain insurance coverage under their parents’ policies.

OBJECTIVE: Assess the impact of the ACA’s dependent care coverage expansion on young adult mortality rates.

RESEARCH DESIGN: Using the Multiple Cause Mortality public use database for 2008-2013, the impact of the ACA is examined with a difference-in-differences analysis of monthly mortality rates using individuals aged 26-30 as a natural control group for young adults aged 19-25.

RESULTS: The average monthly disease-related mortality rate of the 19-25 years old group fell by between 3.1% and 6.1% in the wake of the dependent care coverage expansion. Reduction in mortality was primarily in disease-related causes which are amenable to general medical care such as cardiovascular disease, while mortality due to trauma-related causes, which must be treated regardless of insurance status under preexisting laws, was unaffected.

CONCLUSION: The reduction in mortality from this single provision of the ACA indicates that larger gains in preventable mortality could be made as health insurance coverage continues to expand under the ACA.

PMID: 28263282

McClellan, C. Med Care. 2017; 55(5): 514-519.