Did Obamacare Really Save Lives?

Authored by Robert Murphy via The Mises Institute,

One of the popular objections to the GOP proposals to reform health insurance markets is that the Affordable Care Act (aka “ObamaCare”) saved thousands of lives per year, and hence that tinkering with ObamaCare will literally kill lots of people. For example, Hillary Clinton tweeted out:

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Now to be sure, even if the claim were true, it still wouldn’t follow that coercive redistribution of wealth was morally justified. However, as happens so often in political controversies, libertarians don’t have to choose between property rights and tolerating widespread suffering. Believe it or not, the data suggest that if anything, ObamaCare actually caused more Americans to die.

None of what I write in this piece should be construed as an endorsement of the GOP bills. But the claim that they would “kill lots of people” is not valid.

Oren Cass’s Amazing Takedown

The researcher who alerted me to these awkward facts was the Manhattan Institute’s Oren Cass. Cass makes three important points in his recent study:

#1. The various estimates of the alleged lives saved under ObamaCare were not based on actual mortality data. Rather, these pro-ObamaCare studies relied on previous episodes (such as the implementation of “RomneyCare” in Massachusetts) where the expansion of insurance coverage went hand-in-hand with improved health outcomes. Then, taking this correlation as a “fact,” the pro-ObamaCare researchers multiplied by the expansion of insurance under ObamaCare and came up with an estimate of how many Americans’ lives were saved.

Yet as Cass points out, this procedure is flawed. What the literature actually shows is that expansion of private health insurance coverage contributes to improved health outcomes. But under ObamaCare, the amount of private coverage went down relative to what we would have expected in the absence of the legislation. What really drove the increase in insurance coverage under ObamaCare was the expansion of Medicaid. And here, it is much less obvious that this is a boon for health outcomes, as the now infamous Oregon experiment shows.

Looking at the Aggregate Data

#2. Now that we’ve undercut the foundations of the pro-ObamaCare figures, we can turn to the actual mortality data from the U.S. After all, as Cass says, if ObamaCare really has been avoiding tens of thousands of deaths per year, we should see that in the data.

And yet, we see the opposite. Although the ACA passed in 2010, the full expansion of insurance coverage didn’t kick in until 2014. So the relevant metric is to see what happened to (age-adjusted) mortality rates before and after 2014. Lo and behold:

U.S. Age-Adjusted Mortality Rates per 100,000 (Annual, 2002–2015)

Source: CDC WONDER Database

2017.06.27 ACA and Mortality.png

As the figure shows, if we control for the aging of the population, the mortality rate tends to fall over time. However, for whatever reason, after falling in 2014, the mortality jumped back up in 2015, erasing all the gains since 2013.

To see that this isn’t some artifact of this data set, we can cross-reference this information with life expectancy. Some readers may have been aware that researchers were alarmed in late 2016 when the latest figures showed U.S. life expectancy falling “for the first time in decades.”

Looking at the State-Level Data

#3. But now we come to the third and most devastating component of the Cass study. He is intellectually honest and concedes that the uptick in mortality in 2015 could be a fluke, or it could be a genuine problem due to something other than ObamaCare. For example, there is a festering opioid epidemic in many parts of the US, so perhaps it was just bad luck (for Obama’s legacy) that this public health crisis happened to hit right when his signature legislature fully kicked in.

Yet Cass points out that we still have a pretty good control group to assess the specific impact of the Affordable Care Act’s boost to coverage. Specifically, only 31 states (plus DC) expanded Medicaid under the ACA, while the other 19 states rejected the offer. So if it’s true that the ACA really did “save lives” relative to what otherwise would have happened, but that the absolute mortality rate in the US went up because of some external problem (like the opioid crisis), then we should still expect see mortality rates jumping more in the “red” states that rejected Medicaid expansion.

And yet, as Cass points out in his study, we see the exact opposite. Namely, the states that took advantage of ObamaCare’s Medicaid expansion saw a worse impact on their mortality rates than the states that rejected the expansion.

Conclusion

Although I personally do not yet have a theory on the specific mechanism that may be responsible, I am confident in saying that the actual data do not support the breathless claims that rolling back ObamaCare will literally kill many thousands of Americans.

Fans of the Austrian school should not be shocked, though, to discover that having the federal government get more heavily involved in the health sector has apparently made things worse.

 

Comments

chosen (not verified) Jun 30, 2017 9:24 PM Permalink

It is sort of simple.  Obamacare just postponed the deaths of people who would have died earlier under the pre-Obamacare regime.  The only winners are the people who got to live a year longer, but probably not much fun for them anyway, and the doctors and hospitals who made a ton of money by briefly prolonging the lives of these people.

Let it Go Jun 30, 2017 7:12 PM Permalink

It is interesting how real life can bring truth front and center exposing flaws in a policy. When to seek medical treatment is a personal issue, but the decision is often impacted by just what kind of coverage a person has. Today many people have coverage with a deductible so high that they are afraid to use it.In some ways this is akin to having no coverage at all and this poses a massive problem. Many people today suffer the worst of both worlds, not only have premiums rocketed through the roof, but soaring deductibles have made using the coverage a gamble and a painful experience. The article below tells how trying to avoid running up a bill became a near death experience.http://brucewilds.blogspot.com/2016/01/obamacare-can-kill-you.html

csmith Jun 30, 2017 3:36 PM Permalink

"Namely, the states that took advantage of ObamaCare’s Medicaid expansion saw a worse impact on their mortality rates than the states that rejected the expansion."Expand Medicaid = less personal responsibility for one's health = greater mortality.

Hubbs Jun 30, 2017 2:03 PM Permalink

The immediate question  is whether the the higher co pays and deductibles resulted in more deaths because fiancially depleted premium paying people were simply now unable to afford access to health care, or being the cynic that I am, have lives been actually saved because people didn't see the doctor (again, because they can no longer afford the co pays or deductibles, having been depleted financially from paying the exhorbitant premiums)?

headless blogger Jun 30, 2017 1:01 PM Permalink

I believe I've told this story here before but I think its worth repeating. My sister used to work for one of the Call centers for ObomberCare (East Coast) when they first started. She quit in 2015 after seeing what goes on. She said they have an Interpreter line, where the CSR calls and requests an interpreter from most languages.One day a lady called who could not speak English so she said she got an interpreter. The lady was from some obscure place she had never heard of, even though she's really good with geography. Turns out this woman came to the USA in 2013 and must have immediately got citizenship because my sister said she was a citizen. She was on Full SS Disability and was also receiving free healthcare through Medicaid.She also said that almost everyone that called either was put on Medicaid or had large Reduced Premiums based on income (the Tax credit wing of the program).She had so many stories about that place, but got out of there when she saw how this was working. She is a strong Anti-ObomberCare person to this day.

headless blogger Jun 30, 2017 12:50 PM Permalink

They need more time and data to make the conclusion they make. From 2004-2005, according to the chart, deaths went up, also. Plus, even if the death rate went down over time with ObomberCare, it would still cause an eventual crisis in the cost, so it is unsustainable as-is.

insanelysane Jun 30, 2017 12:45 PM Permalink

There should never be an article titled "Did Obamacare Save Lives?" on a website that has the tag "On a long enough timeline the survival rate for everyone drops to zero."I hate to tell you folks but humans are mortal and no amount of health insurance coverage can change that.  Healthcare may extend lives but it can't defeat death.

incharge1976 Jun 30, 2017 12:03 PM Permalink

Most of Medicaid was expanded and shifted over to Obamacare to give off the illusion that millions of people were signing up. A vast majority is nothing more than someone in a state like NJ getting placed on Obamacare and the federal government calling is an Obamacare signup. That's the reason insurance companies are dropping out. Having the government shift tens of thousands of Medicaid users onto your system and not then having the government limit payouts is not profitable. 

Mr. Crisp Jun 30, 2017 11:59 AM Permalink

Looking at the mortality rate in the graph above, the mortality rate started leveling off in early 2009, when Obomacare was first being formulated in Congress. It was a killer right from the get-go.

numapepi Jun 30, 2017 11:46 AM Permalink

Whenever politicians, journalists and/or the cultural elite bring life and death into a political debate they open the door to violence.

When journalists claim, "lives will be lost" they are invoking violence. Because, the fundamental right of all living things is the right to defend one's life. Since the media are claiming, lives will be lost, they are telling people that they either act violently to save their own lives else they lay down their lives.

SRV Jun 30, 2017 11:34 AM Permalink

Solid data analysis... but clearly a corporate agenda in defence of corporate, For Profit Healthcare...That IS the problem, as the Insurance Companies alone take out over $20B a year in profit... then add the profit in all those private hospitals and clinics, and the insanely inefficient system doctors working of hundreds of insurors to identify what procedures won't bankrupt the patient's family... ALL IN THE NAME OF CORPORATE PROFIT! They don't exist in a single pay system where costs are managed through a single non profit agency... but they've spent billions convincing most Americans to "defend" the worst health care system in the developed world to the death.Meh...Oh, one other part of the puzzle never mentioned is the non-progressive nature of the healthcare cost structure, that forces the low income masses (growing every day) not poor enough for the Medicaid Patch to pay multiple times more as a percent of income than the rich.The single pay system is based on the same progressive (still heavily skewed to the rich) structure in the income tax system... but of course the low income masses (with no voice) are cast aside in order to provide the best care in the developed world, for those who can afford the Cadillac Plan for a small percentage of their income.

Expat Jun 30, 2017 11:08 AM Permalink

Awesome statistical analysis.  One set of data from one year to the next.  Wait a second while I flip this coin....okay, it came up heads.  That proves that this coin will show heads 100% of the time.Okay, i get it.  You hate Obama.   You hate healthcare.  You think people should die dignified deaths by suffocating from illness-induced debt.  Goody for you.  So you cherry pick a data set.Given the small variation and the record low US mortality in 2014, this analysis is frankly worthless, though it sure looks sexy if you are both stupid and right-wing.  Aside from the data set being too small (hello selection bias), you cannot examine the alternative reality where there was no ACA.  Perhaps US mortality would have been 10% higher in 2015.Come back in five to ten years...assuming you have not died from a disease you can't afford to treat under Trump "Care".

aloha_snakbar Jun 30, 2017 11:05 AM Permalink

If republicans pass this bill, they are the death partyReally? Too bad there are no statistics about white people who pay for this crap, who suddenly cannot afford to go to the doctor, get sick and die. Just so the lowest IQ, most unproductive residents (blacks) and illegals can have free / cheap healthcare. That is one truly evil and fucked up system...

Expat aloha_snakbar Jun 30, 2017 11:11 AM Permalink

Well, you are racist and ignorant.  Minorities and illegals have appalling health care.  Often their only choice is the ER but that does not cover preventive medicine or treatment of ongoing disease.    If you think the healthcare obtained by these groups are so fucking awesome, why not cancel your own insurance and just do what they do?  Well?  I guess not.  Try studying the issue and come back when you are less of an asshole.

In reply to by aloha_snakbar

Everybodys All… Jun 30, 2017 11:01 AM Permalink

How many young Americans mired in the Obama economy, burdensome debt, and government overreach in their lives just said fuck it and turned to opiods? How much of this was created from the Afghanistan/Pakistan CIA rat line under Obama?

swmnguy Jun 30, 2017 10:57 AM Permalink

Funny, isn't it; the Von Mises people rail about the immorality of forcible redistribution of wealth, but only if it affects the wealthy.  They never seem to mind the forcible redistribution of wealth upwards.  They and the Finance Sector seems to believe ObamaCare didn't extract enough wealth from the middle and lower classes (those who derive their income from paychecks) fast enough, and redistribute it upward fast enough.  They seem to be addressing this flaw in the various GOP proposals being pulled together at the last minute like the class clown doing his term paper on the bus on the way to school to turn it in.ObamaCare was a temporary bailout measure at best anyway.  It was going to collapse because the combination of private insurance, corporate care providers, pharma and devices produces the very predictable outcome of a price spiral that escalates to the point that a critical mass of Americans and their employers can no longer pay the costs.  ObamaCare delayed the collapse by a couple of years.The insurance companies want out of the Individual market because they've priced their product out of reach of that sector.  Hence the "Exchanges."  All the rules drive people toward employer-provided coverage.  I can't use the exchanges because my wife's employer does offer family coverage.  But while the offer a very generous subsidy to the employee, they contribute nothing to the cost of family coverage.  If we took that coverage, my wife wouldn't get a paycheck.  So I buy on the Individual market for myself and our two kids, but now I can't use my HSA at all; can't contribute to it, can't use the money in it.  Nice.  It's only 5%-8% of the country that doesn't get coverage from employers or government anyway so nobody cares.  Now with proposed cuts to the government programs, the choice selected for us is either employer-provided coverage or none at all that anyone can pay for.Meanwhile, health insurance is the second-largest cost to employers, after payroll itself.  It's a huge competitive disadvantage globally for US business.  That will be the next domino to fall in the ongoing collapse, but by then the wealth of most employers will have been extracted and redistributed upward too, so the Finance Sector won't care by then.Anybody seeking to rebuild the voter coalition that brought Trump to the Presidency, perhaps Trump himself in a couple years, is going to have to offer those voters something.  I'm guessing it will be not even half a loaf, but a few moldy bread-heels, in the form of the privilege of paying premiums to go onto Medicare.

Ghordius Jun 30, 2017 10:47 AM Permalink

if you pose the wrong question, you might get the wrong answerthe real question is:do "single payer" healthcare systems like the British NHS work? do they save lives, do they ease the worry of people that might get caught by illness without funds to pay for a hospital? are they affordable, are they the "hallmark of a civilized country"?now, try to pose those question to let's say an average Brit. you might get a strange stare, though, until the realization that you are from the US sinks inmeanwhile, both the existing "Obamacare" and the proposed variants of "Trumpcare" still smack of an extremely bad copy of the Swiss system, which was the most expensive one until "Obamacare" was introducedand... has any other country looked at the way the US manages healthcare and said: "wow, we have to copy that"?was it Churchill that said Americans eventually and invariably do the right thing, but only after they have properly explored all other options? I'll take that as a bit of hope. go on exploring, dear cousins

hooligan2009 Jun 30, 2017 10:43 AM Permalink

a politician has no clue about whether a left or right wing biased policy works or does not work.in other words, there neither is now, or has been in the past, ANY policy that shows that government intervention in health care provision provides a more favorable outcome IN TERMS OF THE MORTALITY RATE.however, this does not cover other health issues like cancer, diabetes or opiod related diseases.usually, there is a point to an action. politicians, as usual, have no point/objective  - or a metric by whch to judge any kind of success.in the meanwhile, the killer drugs masquerading as treatment - opiods - go on killing and maiming the organs of americans completely unchecked and, in fact, approved by the corrupt and useless FDA.so does the price gouging my drug companies of drugs that cost a few cents to produce yet are charged at hundreds if not thousands of dollars.and still, those states that provide better health care than other states for a cheaper price cannot treat patients from other states - because of politicians.drain the fucking swamp already and sentence libtard socialists to health treatment in the most expensive states with the poorest quality (and highest taxes - funny that hey?) .bleh

mary mary Jun 30, 2017 10:42 AM Permalink

I bet Obamacare resulted in increases in medicine costs.  I know my Medicare Part B pharmaceutical insurance provider increased my deductibles.  I'm not on Obamacare, but I suspect that Obamacare gave my insurer the "green light" it was waiting for.  To increase everyone's deductibles.I also think this is the primary reason Congress is having such a hard time repealing Obamacare: Big Insurance, Big Pharma, and Big Hospitals all contribute enormous amounts to political campaigns.  They also spend enormous amounts on television advertising, and MSM responds by endlessly propagandizing that repealing Obamacare would be "cruel and heartless".  Yeah, sure, "cruel and heartless" to the bottom lines of the CEOs of Big Insurance, Big Pharma, and Big Hospitals.

az_patriot (not verified) Jun 30, 2017 10:39 AM Permalink

Obamacare only benefits a very small number of extremely low-IQ vagrants, hooligans, and illegals, and is nothing but wealth redistribution in disguise.  There's nothing beneficial about it all, and those very small number of people can be parked under Medicaid or Medicare, and it would be a WHOLE lot cheaper.

Peter41 Jun 30, 2017 10:36 AM Permalink

The gov't healthcare record is reflected quite well in the VA heath care system. Top down, bureaucratic governance kills in the healthcare sphere.