A new New England Journal of Medicine report found that expanding health insurance coverage increases access to care and improves health outcomes.
In the report, “Health Insurance Coverage and Health — What the Recent Evidence Tells Us,” Drs. Benjamin D. Sommers, Atul A. Gawande and Katherine Baicker reviewed recent studies on the topic of health insurance coverage and its effect on Americans’ health.
- The report found there are still many unanswered questions about U.S. health insurance policy, such as the best way to structure coverage “to maximize health and value and how much public spending we want to devote to subsidizing coverage for people who cannot afford it.”
Foes of the Affordable Care Act (ACA) and expanding Medicaid often point to the claim that health insurance coverage doesn't guarantee better health. They also argue that Americans can still get emergency care regardless of whether they have health insurance coverage.
This new report, which analyzed multiple studies on the topic, disagrees with those arguments. The report’s authors said the belief that lacking health insurance doesn't kill Americans isn’t true.
These findings are especially timely as Senate leaders hope to debate a 142-page healthcare reform plan this week. The Congressional Budget Office announced on Monday that the bill would result in 22 million Americans losing health insurance by 2026, including 15 million next year.
More coverage improves health, but that also comes with a higher price tag through greater use of services. However, the authors said studies show that expanding health insurance is still cost-effective. Hospitals typically benefit when more people have insurance because they are on the hook for less charity care and patient volumes increase.
The study authors concentrated on the more recent experimental and quasi-experimental studies of the ACA and other public and private insurance expansions, such as Massachusetts’ health reform, which was the basis of the ACA.
The report said health insurance helps people manage financial risk. The authors pointed to the Oregon Health Insurance Experiment, which selected people by lottery from a Medicaid waiting list that showed those chosen “experienced major gains in financial well-being as compared with those who were not selected.”
Health insurance also leads to greater access to primary care, preventive services, chronic illness treatment, medications, surgery, more ambulatory care visits, increased use of prescription medications and better medication adherence.
“These increases appear to produce significant, multifaceted, and nuanced benefits to health. Some benefits may manifest in earlier detection of disease, some in better medication adherence and management of chronic conditions, and some in the psychological well-being born of knowing one can afford care when one gets sick,” according to the report.
“Factoring in enhanced well-being, mental health, and other outcomes would only further improve the cost-benefit ratio. But ultimately, policymakers and other stakeholders must decide how much they value these improvements in health, relative to other uses of public resources — from spending them on education and other social services to reducing taxes.”