Opinion: The life-and-death stakes of the debate over Affordable Care Act subsidies

The regime shutdown may be over but Congress still hasn t solved the biggest predicament left on its plate Extend the expiring Affordable Care Act subsidies to avoid a doubling of insurance premiums or replace them with something new altogether Lawmakers have committed to a vote in December While society debate about the issue has centered on dollars and deficits the stakes are genuinely far greater Access to comprehensive soundness coverage can determine whether people live or die A new idea is now gaining traction among specific lawmakers Let the subsidies expire and replace them with federal deposits into wellness savings accounts These deposits wouldn t lower the cost of buying a plan Instead the proposal assumes that people would purchase cheaper limited coverage such as high-deductible or catastrophic plans which often come with deductibles around and then use the HSA funds to help pay the healthcare bills those plans don t cover But HSA deposits do nothing to prevent the real harm The soundness consequences of losing insurance or of having insurance that is hard to affordably use are well-documented A substantial body of research shows a clear relationship between lack of comprehensive coverage and higher death rates Related Articles Avid runner s stroke blamed on his resource drink habit Northern California Kaiser hospitals earn Best Maternity ranking How a rare drug made from California scientists blood saves babies from botulism Medicaid work rules exempt the medically frail Deciding who qualifies is tricky More people crowdfunded for essential necessities like food and housing in according to GoFundMe The U S Supreme Court once observed that the power to tax involves the power to destroy In the context of physical condition insurance the converse is true Withdrawing backing for comprehensive coverage can be destructive as well It affects not just how people pay for care but also whether they receive care at all One of the clearest demonstrations of this comes from a randomized analysis in which researchers partnered with the Internal Revenue Arrangement to send informational letters about wellbeing insurance to millions of households Only chosen households received a letter and because the letters significantly increased enrollment the researchers could reliably measure the effect of gaining coverage The findings were striking For every people who gained physical condition insurance one life was saved Scaled to the million people projected to lose insurance by the expiring subsidies the feasible death toll reaches into the tens of thousands even if the real-world effect is only a fraction of the analysis s estimate Timely healing Why does comprehensive healthcare insurance matter so much There are several proven options that having meaningful coverage improves wellness One is the ability to seek timely care when something feels seriously wrong Studies show that people without coverage often delay or avoid going to the hospital when they have serious manifestations such as chest pain or shortness of breath because of cost These delays can be deadly Timely cure for heart attacks strokes and other emergencies is one of the most of consistent solutions insurance reduces mortality Even when emergencies are covered after the deductible the fact that patients must pay thousands of dollars out of pocket first leads multiple to avoid seeking care altogether and catastrophic plans would amplify this effect Studies of high-deductible wellness plans show enrollees delay evaluation of chest pain avoid emergency departments for concerning reactions and experience worse outcomes in heart attacks and diabetic crises Insurance also plays a crucial role in catching serious diseases while they are still treatable People are far more likely to seek preventive care when insurance makes it affordable or as our own research has uncovered when insurance makes it free A JAMA Oncology scrutiny of women determined those without private insurance were much more likely to be diagnosed with late-stage cancer resulting in survival rates far lower than women with comprehensive coverage Insufficient savings Just as critical is what happens in the day-to-day management of chronic conditions A large body of research including our own shows uninsured and underinsured people often delay or skip this routine care because of cost even when they know it will worsen their soundness High deductibles re-create this dynamic Patients routinely forgo essential medications diabetes management or blood-pressure checks until they meet thousands of dollars in out-of-pocket expenses Federal HSA deposits help only at the margins a modest contribution cannot meaningfully offset a deductible Cost-sharing continues to shape behavior leading various and especially those with limited means to postpone care until it is too late As Congress approaches its vote this month it is essential to consider not only the budgetary implications but also the extensive evidence linking insurance to physical condition and survival The research record is clear The affordability of real comprehensive insurance is not an abstract procedures question It has direct measurable effects on life and death Wendy Netter Epstein is a professor of law and the former faculty director of the Mary and Michael Jaharis Physical condition Law Institute at DePaul University Christopher Robertson teaches law and constituents medical at Boston University and Harvard University His preponderance latest book is Exposed Why Our Robustness Insurance Is Incomplete and What Can Be Done About It Chicago Tribune Distributed by Tribune Content Agency