WASHINGTON - Being uninsured substantially raises the risk of dying, according to a comprehensive review of studies published today in the Annals of Internal Medicine. The review updated a 2002 study conducted by the Institute of Medicine (IOM - now called the National Academy of Medicine) that concluded that 18,000 persons died each year from lack of health insurance.



The authors carried out an intensive search for all research examining whether health insurance coverage affects overall mortality among adults age 18-64. They found that multiple studies published since the completion of the IOM study have confirmed that insurance lowers mortality. They cite consistent findings from a randomized trial carried out in Oregon, as well as multiple quasi-experimental and observational studies. The studies indicate that insurance decreases the odds of dying among adults by at least 3% and as much as 29%.



The authors conclude that health insurance prevents deaths at least in part by improving the diagnosis and treatment of high blood pressure. The review cites results from several studies, including randomized trials, showing that uninsured and under-insured Americans are less likely to have their hypertension diagnosed; that insurance leads to lower and safer blood pressure levels; and that eliminating financial barriers to hypertension care dramatically decreases all-cause mortality. Studies have also shown that lack of coverage increases death rates in many other conditions, including breast cancer and major trauma.



Dr. Steffie Woolhandler, lead author of the article who is an internist in the South Bronx, Distinguished Professor of Public Health at the City University of New York at Hunter College (CUNY) and lecturer in medicine at Harvard noted: “In order to justify policies that strip coverage from millions, Republicans like Sen. Ted Cruz and Rep. Raúl Labrador claim that health insurance doesn't save lives. But overwhelming scientific evidence says they're wrong. Thousands of people are already dying each year because the Affordable Care Act (ACA) has left 28 million uninsured. The Republican health reform bills would increase that death toll.”



Study co-author Dr. David Himmelstein commented: “According to the CBO, the Senate Republicans’ plan would strip coverage from 22 million Americans. The best estimate based on scientific studies is that about 29,000 Americans would die each year as a result. We need to move forward from the ACA to a single payer reform that would cover all Americans, not backwards through repeal.” Dr. Himmelstein, like Dr. Woolhandler, is an internist, Distinguished Professor at CUNY and lecturer at Harvard.







“The Relationship of Health Insurance and Mortality: Is Lack of Insurance Deadly?” by Steffie Woolhandler, M.D., M.P.H. and David U. Himmelstein, M.D. Annals of Internal Medicine. Published online, June 26, 2017. The Annals of Internal Medicine is the official journal of the American College of Physicians.



Disclosures: Drs. Woolhandler and Himmelstein co-founded Physicians for a National Health Program (www.pnhp.org), a nonprofit educational and research organization that supports a single-payer national health plan; they also served as advisers to Sen. Bernie Sanders’ presidential campaign. Neither the Sanders campaign nor PNHP played any role in funding or otherwise supporting the commentary. They tweet @shadowingTrump.

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