Last week, Republicans in the U.S. House of Representatives pushed their “American Health Care Act” — their promised replacement for the Affordable Care Act (“ACA”), a/k/a “Obamacare” — through two House committees in marathon meetings. They did so even though the text of the bill was keep secret until two days before those committee hearings, and even though the Congressional Budget Office (“CBO”) had not issued its estimate, or “score,” of the probable impact on that bill on the federal budget and on the number of persons in the U.S. who have health insurance.
Now we know the CBO’s scoring. It issued an estimate today that the Republican bill will cause 24 million people to lose their health insurance coverage. Specifically, the CBO estimated that by next year, 14 million people will lose their coverage, compared with levels under “Obamacare,” and that number will grow to 24 billion by 2026 as a result of cuts to Medicaid that are supposed to take effect beginning in 2020.
What will be the impact of that 24 million person increase in the ranks of the uninsured on death rates in the U.S.? The CBO report is silent on that subject. However, we can calculate the probable change in the death rate by extrapolating from a 2009 study, conducted by Harvard Medical School and the Cambridge Health Alliance, that was published in the American Journal of Public Health.
That study estimated that, at a time when there were about 50 million people in the United States without health insurance:
- The mortality rate for the uninsured was 40% higher than the mortality rate for people who had health insurance; and
- About 45,000 people per year died as a result of their lack of health insurance.
With 24 million people losing health insurance as a result of this new law, should it be passed, that translates to about 21,600 additional deaths per year. That means that, on average, one person would die every 24 minutes as a result of this bill. That does not include the people who would have to file for bankruptcy because they had incurred medical bills that, now, are covered by the ACA.
This could be an optimistic estimate. Conservative Republicans in the House are reportedly insisting on introducing cuts to Medicaid in 2018, as opposed to the plans in the current bill to make them effective in 2020. Any changes to this bill that would make health care even less affordable would increase the uninsurance rates even higher and would increase the death rates above these estimates.
There is a simple word to describe what the Republicans are proposing to do. That word is “murder.” The Republican Party is proposing to murder some 21,600 people each year, year in and year out, by making health insurance unaffordable for tens of millions of people.
My use of that word is not hyperbole. The Colorado statute setting forth the elements of murder in the first degree provides that a person is guilty of that crime if he or she:
Under circumstances evidencing an attitude of universal malice manifesting extreme indifference to the value of human life generally, he knowingly engages in conduct which creates a grave risk of death to a person, or persons, other than himself, and thereby causes the death of another.
C.R.S. § 18-3-102(1)(d) (2016).
Any person, and in particular any politician elected to public office, who knowingly passes a law that a bipartisan office of the United States Congress reports will lead to 24 million people losing their health insurance, at a predictable cost of hundreds of thousands of lives within just the first ten years, has displayed “an attitude of universal malice manifesting extreme indifference to the value of human life generally.” That legislative act would create “a grave risk of death to a person, or persons,” other than to the legislator, and would “cause[ ] the death of another.” Any Republican legislator who objects to this analysis should be required to explain why he or she is moving forward with a bill that will cause this level of death, disease, bankruptcy and personal despair.
And if any Republican believes that this term is still too harsh, that person should admit that the “American Health Care Act” will cause hundreds of thousands of people to die prematurely. Sarah Palin and some Republicans in Congress made the memorable and wildly inaccurate claim that the ACA would lead to, if not require, the establishment of “death panels” for Americans. Those who falsely proclaimed “death panels” should not be heard to complain when they are, themselves, part of the real death panels that will lead, inevitably, to massive and unnecessary levels of death.
It is not settled that this bill will become law. As a result of public outrage and totally justified fears about the result of this effort to repeal the ACA with an extremely flawed and grossly inadequate substitute, Congressional Republicans may yet abandon to repeal and replace Obamacare. They may yet decide to improve the law, rather than to try to replace it. But given the Republicans’ refusal to even delay consideration of this bill until after they had received the CBO scores, that appears highly unlikely.