Expanding health insurance in the United States saves lives.
In 2006, Massachusetts began requiring health insurance coverage for nearly all residents – years before the rest of the country. Now a study shows that after the reforms went into effect, the state saw a 2.9 per cent decrease in the death rate through 2010. According to the study, which was led by Benjamin Sommers of the Harvard School of Public Health in Boston, that translates to around 320 lives saved every year.
The finding hints at the benefits that may soon be felt in the rest of the US, where since October millions of Americans have signed up for insurance under the federal Affordable Care Act (ACA), which is modelled on the Massachusetts system. Often referred to as "Obamacare", the program calls for every American who can afford health insurance to obtain it or face a financial penalty.
To figure out how expanding health insurance
Die less, live more
The researchers found that the state's mortality rate decreased starting in 2006, after the implementation of the new system. The change was more pronounced in lower-income counties, which saw a three per cent drop in the death rate compared to just 1.8 per cent for high-income counties. Deaths among people suffering from conditions that would be expected to improve through access to healthcare, such as cancer, heart disease and infectious disease, also dropped by 4.5 per cent.
"Our study adds to a growing body of evidence that getting health insurance makes a real difference for people – 320 fewer deaths per year is a pretty big deal," says Sommers.
The Massachusetts reforms were a blueprint for Obamacare. Both laws require citizens to purchase health insurance if they can afford it, and offer government subsidies for those who cannot. The federal program also asks all states to set up special exchanges like that in Massachusetts where people can compare available insurance policies against each other.
Greater impact
Past research suggests that the Massachusetts healthcare law has had other beneficial effects outside of lower death rates. A study from the National Bureau of Economic Research in 2010 found that there were fewer hospital visits after the state's reforms. Another study, released last year, showed that between one and two per cent of Massachusetts residents reported better health statuses.
Massachusetts had only limited room for improvement, says Martin McKee, co-director of the European Center on Health of Societies in Transition in London. Even before the law took effect, the state ranked highly in the number of people insured and the overall health of its population. That means that other parts of the country could stand to improve even more with the ACA.
"Expanded coverage is likely to have a much greater impact in other states that have much higher rates of amenable mortality," he says.
John Ayanian, director of the Institute for Healthcare Policy and Innovation at the University of Michigan, agrees. But he also points out that the study showed that the Massachusetts program had some of its greatest gains in lower income portions of the population. Under Obamacare, those who can't afford health insurance were meant to get coverage through a voluntary expansion of Medicaid programs at the state level. But this provision is not mandatory, and only 26 states and the District of Columbia have so far elected to expand their Medicaid programs.
"States that aren't expanding their Medicaid program under the ACA may be leaving their residents with lower incomes out," he says.
Journal reference: accepted for publication in Annals of Internal Medicine
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