Harvard: Pre-ACA, 45,000 Americans Died Annually From Lack Of Health Insurance

Nearly 45,000 Americans suffered preventable deaths due to lack of health insurance prior to the Affordable Care Act.

Before President Barack Obama signed the Affordable Care Act into law, tens of thousands of Americans died each year due to lack of health insurance, according to a 2009 joint study by Harvard Medical School and Cambridge Health Alliance.

The researchers found that uninsured, working-age Americans had a 40 percent higher risk of death compared to their insured peers.

“The uninsured have a higher risk of death when compared to the privately insured, even after taking into account socioeconomics, health behaviors, and baseline health,” said lead author Andrew Wilper, M.D., who currently teaches at the University of Washington School of Medicine. “We doctors have many new ways to prevent deaths from hypertension, diabetes, and heart disease — but only if patients can get into our offices and afford their medications.”

Analyzing data from the Centers for Disease Control and Prevention (CDC), the researchers accounted for numerous factors in death rates, including education, income, smoking, drinking, and obesity.

The study estimated nearly 45,000 deaths each year due to lack of health insurance.

Deaths associated with lack of health insurance now exceed those caused by many common killers such as kidney disease. An increase in the number of uninsured and an eroding medical safety net for the disadvantaged likely explain the substantial increase in the number of deaths, as the uninsured are more likely to go without needed care.

Another factor contributing to the widening gap in the risk of death between those who have insurance and those who do not is the improved quality of care for those who can get it.

The Republican goal of abolishing the ACA – particularly without a plan to mitigate negative impacts – would likely result in a return to such conditions.

When Obama claimed in 2015 that the new health care law had prevented 50,000 deaths in the U.S., Lucian Leape – adjunct professor of health policy at Harvard University’s T.H. Chan School of Public Health – told PolitiFact the numbers were credible.

Leape, who has been studying preventable hospital deaths since the early 1990s, credited improved data collection and the work of Partnership for Patients, "which has been a serious – and successful – effort to engage hospitals in achieving specific goals, such as reducing infections." He said it’s the kind of effort he and others called for a decade and a half ago but "never got before the ACA. Hospitals were improving their safety slowly on their own, and this gave it a big boost. It's the first time we have seen measurable, significant decreases in any of the harms that we cause by treatment failures."

David Nash, dean of the Jefferson School of Population Health in Philadelphia, agreed that the numbers are credible. "This is in part due to a huge amount of work on the part of hospitals," Nash said.

Steffie Woolhandler, a co-author of the Harvard study and professor of medicine at Harvard Medical School, highlighted the two major problems with the pre-ACA system of health insurance:

“Historically, every other developed nation has achieved universal health care through some form of nonprofit national health insurance. Our failure to do so means that all Americans pay higher health care costs, and 45,000 pay with their lives.”

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