A brilliant commenter at Cafe Hayek observed, “Health care is one sixth of the U.S. economy, but no one wants to pay one sixth of their income for it.”
The best statistical estimate for the number of lives saved each year by the Affordable Care Act (ACA) is zero. Certainly, there are individuals who have benefited from various of its provisions. But attempts to claim broader effects on public health or thousands of lives saved rely upon extrapolation from past studies that focus on the value of private health insurance. The ACA, however, has expanded coverage through Medicaid, a public program that, according to several studies, has failed to improve health outcomes for recipients. In fact, public health trends since the implementation of the ACA have worsened, with 80,000 more deaths in 2015 than had mortality continued declining during 2014–15 at the rate achieved during 2000–2013.
The Affordable Care Act has led to substantial increases in Medicaid enrollment but shows no effect in the aggregate on private insurance coverage; a lower share of non-elderly Americans had private insurance in 2015 than at the start of the recession in 2007–08.
- Economic recovery, not the ACA, has driven changes in private insurance coverage: during 2007–10, total employment fell 5.5% and private insurance coverage fell 7.0%; during 2010–15, total employment rose 8.8% and private insurance coverage rose 9.5%.
- The share of non-elderly Americans with private health insurance fell from 66.8% in 2007 to 65.6% in 2015.
- By contrast, the share of non-elderly Americans enrolled in public insurance, primarily Medicaid, has increased from 18.1% in 2007 to 25.3% in 2015, accounting for the entire reduction in the uninsured share of the population.
Studies showing positive effects from health-insurance coverage focus on private insurance, not Medicaid.
- In Oregon, researchers studied the effects of expanding Medicaid coverage and found no improvement in health outcomes. Numerous other studies support this finding for specific conditions and procedures, for Medicaid expansions and for public health spending generally.
- Where studies do find that Medicaid has a positive effect, it is for pregnant women and young children— groups whose coverage was not expanded by the ACA.
A statistical claim that the ACA saves large numbers of lives should be supported by evidence that it has reduced mortality rates; yet the opposite occurred.
- In 2015, age-adjusted mortality rose and life expectancy declined in the United States for the first time since the early 1990s.
- Nor is it the case that states adopting the ACA’s optional Medicaid expansion performed better than those rejecting it; to the contrary, mortality in 2015 rose more in Medicaid expansion states.
- Despite implementation of the ACA, there were 80,000 more deaths in 2015 than had mortality continued to decline during 2014–15 at the same rate as during 2000–2013.