Being uninsured means you live sicker, die younger, and are one emergency away from financial ruin. But we’ve also made the case that even insured folks face a “hidden tax” of higher premiums because of a high uninsured rate due to uncompensated care. And as medical costs are a major cause of bankruptcy, a high uninsured rate also doesn’t help a community’s economic stability.
Now there’s evidence that a high uninsured rate also put a strain on the health care system on which we all rely–and has an impact on health outcomes and even mortality, whether we are insured or not.
The Washington Post’s Sarah Kliff reports on this California-based study:
Health-care economist N. Meltem Daysal compared outcomes for insured heart attack patients in California over a six-year period, 1999 to 2006, when the state saw a 19 percent reduction in mortality rates for such cases. Across the state, however, there was huge variation in how health outcomes were improving: San Francisco and Los Angeles had decreases between 26 percent and 30 percent, while in Sacramento, the drop was just 13 percent.
Daysal wanted to know what was different about the patients in the three cities. He controlled for basic demographic information, like age and race, as well as a set of preexisting risk factors that were present at admission, like a history of heart failure or hypertension.
What he saw was cities that treated more uninsured patients seeing worse outcomes for those who came in with coverage. Daysal estimates that, if uninsurance were eliminated, there would be 3 to 5 percent fewer deaths among those who already had coverage.
What’s happening here? Daysal describes it as “negative spillover,” where the hospitals that treat more uninsured patients end up footing a higher bill for uncompensated care. That takes away resources they could be spending on hiring better doctors, upgrading medical equipments or making a whole host of investments that could improve health outcomes. Worse care, for all patients treated at the facility, ensues.
Another reason why we should be proud we have expanded coverage to over 330,000 Californians, and why we need to continue with the important work of the Affordable Care Act. As much as the new law has been heralded for its efforts to provide consumer protections or control costs, we can’t forget the benefits of expanding coverage to millions of Californians and Americans–not just for those newly covered, but for the rest of us.