Next year, about 14 million more Americans could be uninsured if the House-passed version of health care becomes law, according to the Congressional Budget Office analysis, a more pressing issue than the estimated 23 million expected to be affected by 2026.
In addition to the individual burdens of accessing health care without insurance, injecting millions of uninsured people into the health care system would have a sweeping effect on both the system and on public health outcomes, doctors and health experts say.
The revenue cuts “are like cutting off some of the body’s oxygen supply — partial strangulation,” Alan Sager, professor of health law, policy and management at the Boston University School of Public Health, told HuffPost. “They don’t make health care more efficient; rather, they mean that many people get less care.”
Should the law go into effect, lack of coverage will mean fewer people will have the resources to prevent conditions, effectively treat diseases or manage chronic illnesses before a crisis develops. Here are just a few ways that experts see reduced coverage affecting patients next year:
Patients delay care and develop progressive diseases
When patients don’t have health insurance, they tend to delay care or testing until diseases are more advanced, which could lead to complications, necessitate more serious treatments and result in worse health outcomes.
“More uninsured people would lead to people using emergency room care more since they may not seek out primary care. This means that people would only get care when they are really sick, which would mean their health could be permanently affected by something that could have been caught earlier. In my case, that means I’ll be doing a lot less pap smears and diagnosing more cancer.”
―Dr. Kristyn Brandi, obstetrician and gynecologist at Boston Medical Center
“Increasing the number of uninsured Americans could affect physicians’ ability to provide quality preventive care to patients.”
―Dr. Catherine Hough-Telford, Pediatric Health Care Alliance
“Diabetes may go unnoticed in its early stages but can lead to a host of problems that people don’t think about, including blindness and neuropathy. When more people are uninsured, they are less able to obtain access to both primary and specialty care, meaning that when we finally do see them in the ER, some complications that could have been preventable are unfortunately now permanent. All things being equal, the patients we see in the ER will be sicker from not having had insurance than if they had.”
―Dr. Renee Hsia, professor of emergency medicine and health policy at the University of California, San Francisco
Life will be harder for people with chronic diseases
About half of all American adults, or about 117 million people, had at least one chronic health condition as of 2012, according to the U.S. Centers for Disease Control and Prevention. And for many of those people, such as individuals with diabetes, going without medication is not an option, regardless of insurance coverage.
People with chronic diseases will likely to pay more for insurance and are under pressure not to let that coverage lapse, lest they risk being charged by insurers based on their health. And should those chronically ill people lose coverage altogether, the burden of that loss means more people getting sicker before they pay to get medical care. In the case of an uninsured individual with diabetes, for example, lack of health insurance could lead to an amputation rather than a managed disease.
“I am deeply concerned for people with chronic diseases, especially for those with liver diseases and catastrophic conditions requiring organ transplants that might lose the coverage they need.”
―Bill Remak, chairman of the California Hepatitis C Task Force
Hospitals and doctors will be under increasing financial strain
About one-third of rural hospitals operate at a loss, according to Stat, and although rural and urban hospitals have been closing at a similar rate, with about 100 hospitals closing since 2010, those closures take a bigger toll on rural areas. One aspect of the Affordable Care Act that has helped rural hospitals stay afloat is payments through the expansion of Medicaid, something that would slowly diminish under the Republican health care plan. And hospitals in states that have not expanded Medicaid have fought for those lifesaving federal funds.
When a hospital in a rural area closes, residents often have to travel much farther to the next available hospital. And given the link between increased hospital travel time and mortality, closing a rural hospital could at times mean the difference between life and death.
“Hospitals and doctors serving people who are older, sicker, and poorer—and rural and urban places where those people live—will be even more stressed financially. Some will close up shop and others will relocate. Travel time for care will grow. This will mean less care for fewer people at greater cost.”
―Alan Sager, professor of health law, policy and management at the Boston University School of Public Health
Unplanned pregnancy will rise
Although nearly half of pregnancies are unintended, according to the Guttmacher Institute, the United States has made massive gains in reducing teenage pregnancy in recent years, hitting a record low of 22 births per 1,000 teens ages 15 to 19 in 2015, according to the CDC.
Although public health experts can’t completely explain the decline, evidence suggests teens abstaining from sexual activity and using birth control when they do have sex have driven down the teen birth rate. Without reliable access to affordable or even free birth control, many women will no longer be able to effectively prevent pregnancy.
The House bill would allow states to roll back the Obamacare provision for free birth control. It would also prevent Medicaid funds from being used at Planned Parenthood clinics, even for contraceptive services.
“More women may come to me with an unplanned pregnancy because they can no longer afford their birth control without insurance.”
―Dr. Kristyn Brandi, OB/GYN at Boston Medical Center
The opioid epidemic will worsen
Of the 14 million Americans poised to lose insurance, about 420,000 will have diagnosable problems with opioid use. Losing health insurance would mean not being able to afford medication-assisted treatments for opioid addiction, such as buprenorphine, Dr. Peter Friedmann, associate dean for research at the University of Massachusetts Medical School and chief research officer at the nonprofit Baystate Health, noted in an article published in the New England Journal of Medicine in March.
Unaffordable opioid treatments would hit rural areas the hardest, since, as Friedmann points out, the 15 counties with the highest opioid overdose mortality in 2015 were predominantly rural areas in Kentucky and West Virginia.
And since both states opted to expand Medicaid, reversing that insurance expansion could strip tens of thousands of rural Americans of medication-assisted treatment coverage.
“This loss of coverage for addiction treatment, an essential health benefit (EHB) under the ACA, as well as reductions in addiction treatment coverage in states that receive EHB waivers, will have devastating consequences for people, families and communities ravaged by the opioid epidemic.”
―Dr. Peter Friedmann, chief research officer at Baystate Health
We’ll lose the progress we’ve made against sepsis
Sepsis, a severe reaction to infection that can lead to tissue damage, organ failure and death, kills about 258,000 Americans per year, making it the ninth leading cause of disease-related death, according to the CDC.
This will mean less care for fewer people at greater cost.
Alan Sager, professor of health law, policy and management, Boston University School of Public Health
It’s also a disease that disproportionately affects adults older than 65 and the uninsured, who have a higher rate of sepsis-related mortality than insured Americans, according to a 2011 study published in the journal Critical Care.
Timely treatment is critical when it comes to saving lives and reducing injury from sepsis, so having access to insurance and, therefore, health care resources, can be the difference between life and death. We’d unfortunately expect to see an increase in sepsis injuries, such as amputation, and death if more people were without health insurance or had no access to health care resources. This would be tragic, as sepsis is a treatable condition when caught early and people receive appropriate treatment.
―Thomas Heymann, executive director of Sepsis Alliance
The rise of unpredictable pre-existing conditions
When new epidemics break out, such as the rise of the Zika virus, it can suddenly change the public health care picture in ways that couldn’t be predicted.
Since the Zika virus wasn’t an issue when the Affordable Care Act was signed in 2010, mothers of children with Zika-related health problems, such as microcephaly, could end up paying more for their kids’ health insurance or even be priced out of coverage altogether under the new plan, Mother Jones reports.
The CDC estimates that having a child with microcephaly (a Zika-related birth defect that can cause babies to have neurological damage and smaller-than-average heads) could translate to up to $10 million in medical care over the course of a child’s lifetime.
Those expensive medical bills could incentivize insurance companies to charge the parents of children with mircrocephaly more for premiums and to penalize them financially should their insurance coverage lapse. For now, the number of families affected by Zika in the U.S. is small. According to the CDC, there were 64 babies born with Zika-related birth defects in the United States as of May 9.
“You’d have to be very careful as the parent of a child to never have a break in coverage.”
―Karen Pollitz, a senior fellow at the Kaiser Family Foundation, told Mother Jones