David Himmelstein and Steffie Woolhandleris, both professors of public health at the City University of New York at Hunter College, Lecturers in Medicine at Harvard Medical School, and founders of Physicians for a National Health Program, have a sobering message for the nation: repealing Obamacare will be lethal for tens of thousands of Americans every year.
The story is in the data: The biggest and most definitive study of what happens to death rates when Medicaid coverage is expanded, published in the New England Journal of Medicine, found that for every 455 people who gained coverage across several states, one life was saved per year. Applying that figure to even a conservative estimate of 20 million losing coverage in the event of an ACA repeal yields an estimate of 43,956 deaths annually. […]
House Speaker Paul D. Ryan (R-Wis.) and Rep. Tom Price (R-Ga.), who is Trump’s nominee to head the Department of Heath and Human Services, which will be in charge of dismantling the ACA — have advocated in place of the ACA would hollow out the coverage of many who were unaffected by the law, harming them and probably raising their death rates. Abolishing minimum coverage standards for insurance policies would leave insurers and employers free to cut coverage for preventive and reproduction-related care. Allowing interstate insurance sales probably would cause a race to the bottom, with skimpy plans that emanate from lightly regulated states becoming the norm. Block granting Medicaid would leave poor patients at the mercy of state officials, many of whom have shown little concern for the health of the poor. A Medicare voucher program (with the value of the voucher tied to overall inflation rather than more rapid medical inflation) would worsen the coverage of millions of seniors, a problem that would be exacerbated by the proposed ban on full coverage under Medicare supplement policies. In other words, even if Republicans replace the ACA, the plans they’ve put on the table would have devastating consequences.
Popular vote loser Donald Trump has already promised to slash Medicaid spending with block grants—there goes some 10 or more million people with coverage—about 21,000 deaths. No Republican has advocated for maintaining one of the key aspects of coverage under Obamacare—free preventive care, like cancer screenings. Everyone who has health insurance now can get those screenings, along with vaccinations and screenings for things like diabetes and high cholesterol. When they're not available without copay any more, fewer people will use them. Fewer people will find out if they have potentially life-threatening illnesses because of that. Fewer people will get early treatment for cancers that might not have spread if caught earlier.
Just from those two things that we know Republicans say they'll do—or not do—in a replacement plan, we know that there's going to be less care and more expense for millions. That means returning to the bad old days before Obamacare, when tens of thousands of people were dying premature and preventable deaths.