New data published by the department of Health and Human Services indicates that approximately 5 million less Americans are currently enrolled in the Affordable Care Act marketplace for health insurance compared to last year. While the Trump administration attributes this drop to attempts to address fraud, the dip in enrollment occurred after Congress failed to extend tax credits that would have made health premiums more affordable at the end of last year.
While the immediate impact falls on individuals who become uninsured, ripple effects can extend throughout the healthcare system as more Americans lose health insurance. Here’s how public health could be significantly affected in America when millions lose healthcare coverage.
Preventive Medical Care
Health insurance is one of the strongest predictors of whether people receive preventive medical care; which would include routine blood work, annual physical exams, vaccinations and cancer screening. Research shows that Americans without insurance had significantly lower rates of breast, cervical and colon cancer screening rates compared to those with insurance. For the uninsured, this means medical conditions such as high blood pressure and elevated cholesterol as well as some cancers could go undetected until they become advanced and difficult to treat. Getting diagnosed with early stage as opposed to late stage cancer can be the difference in prolonged life. As an example, those diagnosed with early stage lung cancer have a five year survival of 61%, while those diagnosed with advanced stage lung cancer that has spread to other parts of the body have a five year survival of just 7%.
Worsening Of Chronic Medical Conditions
For Americans living with chronic diseases, losing insurance could be devastating. Many Americans rely on ACA coverage to afford medications to treat various diseases such as diabetes, asthma, depression and autoimmune diseases. Without insurance, patients are much more likely to skip doctor appointments, skip or ration medications or even choose not to fill a prescription. This could undoubtedly lead to worse health outcomes for millions who may not be able to afford basic healthcare and medications. As an example, a diabetic that cannot get access to insulin could suffer from diabetic ketoacidosis, a life-threatening condition that occurs when the body does not have access to enough insulin, leading to severe dehydration, coma and even death.
Infectious Diseases
Insurance coverage can also have profound effects on infectious disease prevention. Without health insurance, Americans may delay seeking evaluation for contagious illnesses such as COVID-19, measles or sexually transmitted diseases. When diagnosis and treatment are delayed for such illnesses, the opportunity for these diseases to spread in households and communities increases significantly. Reduced access to vaccinations and other preventive services weaken community health protections, leaving Americans vulnerable to largely preventable infectious diseases.
Paradoxical Increase In Health Costs
Hospitals and emergency departments can also experience increased strain as patients seek care when they are ill and lack insurance. Under the Emergency Medical Treatment and Labor Act, EDs are required to stabilize patients regardless of their ability to pay. When this occurs, hospitals could see rising levels of uncompensated care, which then gets passed along throughout the healthcare system. This can contribute to higher healthcare costs and insurance premiums over time.
Insurance premiums can also increase for those insured through another mechanism. Health insurance markets remain stable when a broad mix of healthy and less healthy individuals join. When healthier Americans disproportionately leave markets because it is unaffordable, insurers are left covering a sicker population, which costs more money. Consequently, this can lead to increased insurance premiums in the future for those that are still part of the insurance marketplace. In this way, when healthy people opt out of insurance, insurance premiums may rise for the sicker individuals still enrolled.
Regardless of policy changes, healthcare affordability remains a bipartisan concern. When millions of Americans lose healthcare coverage, the consequences extend beyond individual families to physicians, hospitals and communities nationwide. The health of the American population ultimately depends on how well they can access timely, preventive and affordable care before illnesses become emergencies.