Last November, I published a short post with rough estimates of the potential number of deaths per year that could result from a repeal of the ACA that was unaccompanied by a real replacement, and provided a rough range of 20,110 – 48,352 excess deaths (based on the “number needed to insure” from two studies as calculated by Sam Dickman et al. and the CBO’s estimate of 22 million more uninsured under Republican legislation).
Since then, we have some new estimates of the number of excess uninsured under repeal legislation. Bernie Sanders tweeted about the number of deaths that could result from ACA repeal, relying on other assumptions:
The Washington Post criticized the number, and assigned Bernie’s tweet four “pinocchios.” However, as Professors of Public Health David Himmelstein and Steffie Woolhandler (and PNHP co-founders) responded in an article also in the Post, Sanders number may actually be too low: they provided an estimate greater than 40,000 (based on 20 million uninsured). Here’s Atul Gawande responding to Himmelstein and Woolhandlers’ figure:
Of course, depending on the exact assumptions used, a range of numbers of estimated deaths can be calculated. The following table provides the potential range of estimated excess deaths per year depending on the assumption utilized.
|
|
Number needed to insure | ||||
| Source | Legislation | Number uninsured | “Low” estimate1 | “Middle” estimate2 | “High” estimate3 |
| 455 | 830 | 1094 | |||
| HHS4 | Number insured by ACA | 20,000,000 | 43,956 | 24,096 | 18,282 |
| Congressional Budget Office5
|
Restoring American’s Healthcare Freedom Reconciliation Act of 2015
(initial) |
18,000,000 | 39,560 | 21,687 | 16,453 |
| (subsequent) | 27,000,000 | 59,341 | 32,530 | 24,680 | |
| (2026) | 32,000,000 | 70,330 | 38,554 | 29,250 | |
| Urban Institute6 | “repeal via reconciliation without replacement” | 29,800,000 | 65,495 | 35,904 | 27,239 |
Needless to say, all are rough approximations. What is important is that many body bags will be necessary if we gut the ACA, numbering in the tens of thousands. Many of these are approximations are even higher than that of Woolstein and Himmelhandler.
Of course, even with the ACA, we will have an estimated 26 million uninsured for 2017, according to the CBO, so the status quo is also very inadequate.
________________________________________________
1 Sommers, B. D., S. K. Long, and K. Baicker. “Changes in Mortality after Massachusetts Health Care Reform: A Quasi-Experimental Study.” Annals of Internal Medicine 160, no. 9 (2014): 585-93. Number needed to insure based on this study as calculated by: Dickman, Sam, David Himmelstein, Danny McCormick, and Steffie Woolhandler. “Opting out of Medicaid expansion: the health and financial impacts.” Health Affairs Blog, January 30 (2014). Available at: http://healthaffairs.org/blog/2014/01/30/opting-out-of-medicaid-expansion-the-health-and-financial-impacts/.
2 Sommers, Benjamin D., Katherine Baicker, and Arnold M. Epstein. “Mortality and Access to Care among Adults after State Medicaid Expansions.” New England Journal of Medicine 367, no. 11 (2012): 1025-34.
3 Wilper, A. P., S. Woolhandler, K. E. Lasser, D. McCormick, D. H. Bor, and D. U. Himmelstein. “Health Insurance and Mortality in US Adults.” Am J Public Health 99, no. 12 (Dec 2009): 2289-95. Number needed to insure based on this study as calculated by: Dickman, Sam, David Himmelstein, Danny McCormick, and Steffie Woolhandler. “Opting out of Medicaid expansion: the health and financial impacts.” Health Affairs Blog, January 30 (2014). Available at: http://healthaffairs.org/blog/2014/01/30/opting-out-of-medicaid-expansion-the-health-and-financial-impacts/.
5 https://www.cbo.gov/publication/52371
6 http://www.urban.org/research/publication/implications-partial-repeal-aca-through-reconciliation
________________
Updated to reflect “low estimate” of 455 number needed to insure, not 457.
Important. Review…thank you