The link between income and quality healthcare
With tensions across the aisle ever-mounting around the Affordable Care Act and “TrumpCare,” bipartisan cooperation on health care reform is almost non-existent. Almost. The GOP currently has been lobbying to repeal the Affordable Care Act (aka the ACA or “ObamaCare), and replace it with H.R. 1628, or the American Health Care Act (AHCA). Many were surprised this week when a letter signed by a bipartisan group of governors was sent to senate leaders of both parties. The letter criticized the house’s health care bill, claiming it would leave out many Americans who rely on the government for essential medical care.
ILLUSTRATION: First published in the New York Times Upshot, showing US counties by income inequality.
It calls into question coverage for the vulnerable and fails to provide the necessary resources to ensure that no one is left out, while shifting significant costs to the state."
said the letter, which was signed by Ohio Gov. John Kasich (R), Montana Gov. Steve Bullock (D), Nevada Gov. Brian Sandoval (R), Colorado Gov. John Hickenlooper (D), Massachusetts Gov. Charlie Baker (R), Pennsylvania Gov. Tom Wolf (D), and Louisiana Gov. John Bel Edwards (D). Every one of these states opted in to the ACA expansion, which provided increased access to care for low income individuals and families, so they stand to lose a lot if the ACA is repealed.
ILLUSTRATION: Originally published in the County Health Rankings and Roadmap Project. Researchers at the University of Wisconsin have collaborated with the Robert Wood Johnson foundation to create a project chock-full of interesting data, information, observations and graphics about health, risk-factors and more. It’s well worth checking out.
The debate around healthcare always brings up the key question; who benefits from these government programs, and who is “left out?” The answer may lie in examining how income affects access to healthcare under current policy.
It’s already known that increased income means a higher average life expectancy; the Urban Institute published some of these differences in “How are Income and Wealth Linked to Health and Longevity?”
At age 25, Americans in the highest income group can expect to live more than six years longer than their poor counterparts (figure 3).12 The Social Security Administration reports that retirees at age 65 are living longer, but since the 1970s those with earnings in the top half of the income distribution have seen their life expectancy increase by more (6.0 years) than those in the bottom half (1.3 years).”
Income is, of course, even more directly linked with access (or lack thereof) to quality health care. Medicaid programs help to shrink that divide. The number of uninsured citizens is undeniably lower in states that have currently expanded medicaid programs.
Let's dig deeper. Beyond that binary "uninsured vs. insured" outlook is research like a recent study by the Commonwealth Fund (“Access to Primary and Preventive Health Care Across States Prior to the Coverage Expansions of the Affordable Care Act,”), which found that low-income access to basic preventative care was substantially increased in states that expanded the ACA. Metrics like this reinforce the reason government-subsidized medical programs have been quickly embraced by millions under the ACA; to provide healthcare to those unable to afford it on their own and consequently reduce the correlation between income and access to care. Seven governors seem to agree.
The democratic governors who signed this letter present no surprise. The DNC is generally aligned against the proposed AHCA. However, Governors Kasich, Sandoval and Baker of Ohio, Massachusetts and Nevada, respectively, are all members of the Republican party, and they're swimming against the party current.
It's easy to see why these governors oppose an ACA repeal when we look at the numbers. Each of their states saw a considerable increase in insured citizens with the expansion of Medicaid: 30% in Ohio, 28% in Massachusetts, and a whopping 89% in Nevada. Each huge percentage increase can be tagged almost entirely to people living near poverty, since Medicaid eligibility is limited to those with an income of 138% or less of the poverty threshold. Without the ACA, families around that poverty line face a daunting coverage gap.
Though families with the very lowest income would still be eligible for some medicaid without the ACA, those between 44% and 100% of the line receive nothing. The AHCA would barely remedy this, offering tax cuts to the wealthiest in society, increasing the coverage gap, enacting strict eligibility restrictions based on pre-existing conditions, and ultimately leading to upwards of 20 million people losing all coverage in the next 10 years.
Bipartisan cooperation presents a refreshing change of pace. At Wellness Warrior, we believe that the basic opportunity to live a healthy, happy life should be a right for every American, and even every person on the planet. As seven governors put it:
To that end, we remain hopeful that there is an opportunity to craft solutions to these challenges that can find support across party lines, delivering improvements to result in a system that is available and affordable for every American...We stand ready to work with you and your colleagues to develop a proposal that is fiscally sound and provides quality, affordable coverage for our most vulnerable citizens.”
- Governors From Both Parties Slam House Healthcare Bill, Call for Bipartisan Senate Approach via The Hill
- The Coverage Gap: Uninsured Pour Adults in States that do not Expand Medicaid via the Kaiser Family Foundation
- How Are Income and Wealth Linked to Health and Longevity? via Urban Institute
- Access to Primary and Preventive Health Care Across States Prior to the Coverage Expansions of the Affordable Care Act via The Commonwealth Fund
- Income Inequality: It's Also Bad for your Health via The New York Times
- The County Health Rankings and Roadmap Project