People asking the ultimate question about the Affordable Care Act--will it actually save lives?--now have an answer, and it's yes.
The documentation comes from a team at the Harvard School of Public Health. Benjamin D. Sommers, Sharon K. Long, and Katherine Baicker conducted the most extensive study of mortality rates in Massachusetts following that state's 2006 health insurance reform, which is the precursor to the ACA.
They found that from 2007 to 2010, overall mortality among Massachusetts residents aged 20 to 64 declined by 2.9% relative to control groups in other states. Mortality from causes amenable to healthcare declined by 4.5%. Those causes include tuberculosis, cancer, cardiac disease--a full list is here. The reduction was even larger in counties with higher pre-reform rates of uninsurance and low income, which of course are the main targets of Obamacare.
The results, according to the authors' calculations, mean that one death per year is prevented for every 830 people gaining health insurance. Harold Pollack of the University of Chicago performs what he calls a heroic extrapolation to conclude that if the ACA brings insurance to 20 million uninsured Americans, that means the reduction of 24,000 deaths a year.
Is that a lot? "That’s almost the number of Americans who die in auto crashes," he observes. "It’s more than the number who die of AIDS or the number who are murdered every year." If the insurance coverage costs, say, an average of $4,000 per person, saving those lives comes to $80 billion a year, or about 2.3% of all federal spending per year. You want to tell us that's not worth the money?
The study's authors are properly cautious about drawing a straight line between the Massachusetts reforms and the reduction in mortality. But they state the implications of their work in stark black-and-white.
"It is challenging," they write, "to identify factors other than healthcare reform that might have produced this pattern of results: a declining mortality rate in Massachusetts since 2007 not present in similar counties elsewhere in the country, primarily for healthcare-amenable causes of death in adults aged 20 to 64 years...concentrated among poor and uninsured areas and not explained by changes in poverty or unemployment rates."
Anti-Obamacare dead-enders will undoubtedly unsheath their keyboards to pick apart the study. It's only one state, they'll complain, it's only four years of data. But as the authors show, their results are reinforced by earlier studies, including a 2012 study by two of the same authors that found measurable reductions of mortality from all causes after Medicaid expansions after 2000 in New York, Maine, and Arizona.
The dead-enders will have their work cut out for them. As health economist Adrianna McIntyre observes, "Sometimes evidence is easy to argue with. This isn’t one of those times."