Facts on Deaths Due to Lack of Health Insurance in US

It’s estimated there are between 20,000 and 45,000 deaths a year due to lack of health insurance. Get the facts on mortality and health insurance in the US by reading our breakdown of past studies and reports below.

The Uninsured and Mortality Rates

A 2012 familiesUSA study shows that more than 130,000 Americans died between 2005 and 2010 because of their lack of health insurance. The number of deaths due to a lack of coverage averaged three per hour and that the issue plagued every state. Other studies have shown those statistics to be high or low, but all studies agree: In America the uninsured are more likely to die than those with insurance.

The uninsured:

• are less likely to have a usual source of care outside of the emergency room
• often go without screenings and preventive care
• often delay or go without needed medical care
• pay more for medical care

Under the ACA (ObamaCare) as of March 2015 about 25% (rough estimate based on enrollment numbers and other polls) who were previously uninsured are now covered. This means that, unless subsidies are made illegal by King V. Burwell, or more changes like states opting out of Medicaid expansion occur, deaths due to lack of health insurance should dramatically decrease by the time the ACA is in full effect by 2025. An estimated 31 million non-elderly Americans of the 40 million uninsured are expected to be insured by 2025. See the Updated Estimates of the Effects of the Insurance Coverage Provisions of the Affordable Care Act, January 2015.

How Many People Die Each Year From Lack of Health Insurance?

Depending upon the study, we can derive that between 20,000 and 45,000 Americans die each year due to a lack of health insurance. To understand where this number comes from, we will need to look at the studies done, compare them to other statistics, and try to separate the role that income inequality plays in the mortality rate of the uninsured.

• In 2009 Harvard Medical School and Cambridge Health Alliance did a study published in the American Journal of Public Health. This study concluded that:
  • 40 percent increased risk of death among the uninsured. (equating to 44,789 excess deaths annually)
  • As expected, death rates were also higher for males (37 percent increase)
  • Current smokers (102 percent increase)
  • Former smokers (42 percent increase)
  • People who said that their health was fair or poor (126 percent increase)
  • Those who examining physicians said were in fair or poor health (222 percent increase).
• The issues one may have with the Harvard study are that there were only 65 participants in the study, and that the data was being compared to old data (which also had a small amount of participants).

“The uninsured have a higher risk of death when compared to the privately insured, even after taking into account socioeconomics, health behaviors, and baseline health,” said lead author Andrew Wilper, M.D., who currently (as of 2009) teaches at the University of Washington School of Medicine. “We doctors have many new ways to prevent deaths from hypertension, diabetes, and heart disease — but only if patients can get into our offices and afford their medications.”

• In 2002 Institute of Medicine (IOM) did a study that concluded that 18,000 died a year due to lack of health insurance. If we updated the IOM report, to match the findings of the Harvard study, we would get about 26,000 deaths a year from lack of health insurance.
• In 2009 IOM did a report called, America’s Uninsured Crisis: Consequences for Health and Health Care, where they concluded:

One in five adults under age 65 and nearly one in ten children are uninsured. Uninsured individuals experience much more risk to their health than insured individuals. In its 2009 report America’s Uninsured Crisis: Consequences for Health and Health Care, the Institute of Medicine points to a chasm between the health care needs of people without health insurance and access to effective health care services. This gap results in needless illness, suffering, and even death.

• Families USA, a nonprofit group that is advocating for the Affordable Care Act, has just released a stunning new estimate. The group says 26,000 people died in 2010 as a result of a lack of health insurance. That’s more than three Americans every hour.
• In 2012 FamiliesUSA did a study that found that over 26,000 deaths of working-age-adults occur each year due to a lack of insurance. More specifically: 26,100 people aged 25 to 64 died for lack of health coverage in 2010, up from 20,350 in 2005 and 18,000 in 2000.
• Most of these studies used a 1993 study from the Journal of the American Medical Association which showed that (with other factors removed) not having insurance increases the risk of death by 25%.
• According to Forbes:

Unfortunately, that 25% estimate relies heavily on a cohort study published in the Journal of the American Medical Association in 1993 – 19 years ago. That study followed two groups of patients, one with insurance, and one without, and found that after adjustment for other factors the uninsured were at a 25% increased risk of death. But as anyone knows, the world was very different in 1993. We’re talking about before the Internet, before Pfizer launched Lipitor, before all sorts of dramatic changes to the nature of health care in America.

Problems With These Studies

There are a few problems with the studies.

1. All studies used small focus groups. We currently have about 320 million Americans living in the US and as of 2017 very roughly 32 million don’t have health insurance (this number used to be about 50 million and could rise or fall depending on the changes to health insurance under Trump). Better transparency and electronic data collection established by the ACA may help us to better track mortality and the uninsured moving forward, but studies thus far have left a lot of room for error. The number could be higher or lower, in truth we don’t have specifics here.
2. It’s hard to separate factors like socioeconomic status from being uninsured. At least pre-ACA, those who have low-incomes have many factors beyond just being uninsured that could impact their overall health. The studies accounted for this, but again the lack of data makes separating a truth mortality rate based on lack of insurance alone difficult.

Conclusion

We can safely say (that with an uninsured rate of about 40 million, and remember that is dropping under the ACA) that somewhere between 20,000 and 40,000 deaths occur each year due to lack of health insurance. We can also say that as many occur from being a man, from being a former smoker, and far more occur due to being a current smoker. We know that socioeconomic status, diet, access to healthcare, and personal wellness play a strong role in mortality rates. We know a lot actually, even considering what we don’t know. We also know that the Affordable Care Act contains a thousand pages of reforms that aim to fix many of the problems that lead to these death rates. If all goes well we could see lower mortality rate, lower health care prices, and less healthcare spending from the economy as a whole.