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Fact check: Could 36,000 people die if the ACA is partially repealed?
January 19, 2017
By Amée LaTour
Ian Millhiser, Justice Editor at Think Progress, recently claimed that “Nearly 36,000 people could die every year, year after year, if the incoming president signs legislation repealing the Affordable Care Act.”[1] He said he based his conclusion on two studies: one predicting that 29.8 million people will lose health insurance if parts of the Affordable Care Act (ACA) are repealed, and another that calculated one less death per year for every 830 adults that gained health insurance under Massachusetts’ reform plan.[2][3]
Do the studies Millhiser uses support the claim that nearly 36,000 people could die every year, year after year, if the Affordable Care Act is repealed?
No. The methodology of each study precludes it as the basis of a credible prediction about the effects from repeal of Obamacare.
Background
Congressional Republicans have begun pursuing partial repeal of the ACA through the process of budget reconciliation. Incorporating repeal provisions in the budget measure would allow passage of the bill by a simple majority vote rather than a 60-vote threshold in the Senate. However, the repeal provisions in this budget resolution must relate to revenue and spending, such as elimination of the Medicaid expansion, subsidies for coverage purchased through the government exchanges, and the individual and employer mandates, which would leave some provisions of the ACA intact until additional actions were taken.[4] As of January 13, 2017, both the House and Senate passed a budget resolution as an initial procedural step that will enable lawmakers to pursue partial repeal of Obamacare.[5]
In addition to writing for Think Progress, Millhiser is a senior fellow at the Center for American Progress, which its website describes as “an independent nonpartisan policy institute that is dedicated to improving the lives of all Americans, through bold, progressive ideas, as well as strong leadership and concerted action.”[6] Millhiser did not respond to Ballotpedia's request for comment regarding his claim.
Massachusetts study
Massachusetts enacted health care reforms in 2006 that expanded Medicaid, imposed an individual mandate to purchase coverage, and provided insurance subsidies for individuals and families with incomes below 300 percent of the federal poverty level.[7] The state’s system has been called a model for the ACA.
Studies on the impact of health insurance coverage on mortality rates have yielded mixed results. Researchers at Harvard University, in their study titled “Changes in Mortality After Massachusetts Health Care Reform,” sought to determine whether the Massachusetts reforms were associated with changes in mortality.[3]
The researchers compared mortality rates in the state before and after the reforms were enacted against a control group in states where health care coverage paralleled the Massachusetts system prior to reform. They calculated that there was one fewer death for approximately every 830 nonelderly adults who gained insurance.[3]
Urban Institute study
The Urban Institute sought to determine the effect on insurance coverage of partial ACA repeal through a budget reconciliation measure.[2]
According to the study, the number of uninsured people would rise by 29.8 million, from 28.9 million to 58.7 million in 2019. Repeal of the individual mandate without repeal of the requirement that insurers cover people with pre-existing conditions would lead to a “near collapse” in the individual market, the researchers concluded, accounting for 7.3 million of the 29.8 million they project will lack insurance.[2]
Incongruity
Several features of these studies prevent the generalization of results that underlay Millhiser’s claim.
First, the Massachusetts researchers emphasized the importance of comparing Massachusetts counties to a control group of counties with similar demographics, economic conditions, and mortality rates, and noted several differences between Massachusetts and the United States generally: “Massachusetts had significantly fewer minorities, more women, lower poverty and uninsured rates, and lower baseline mortality than the rest of the United States.” As a result of such differences, they stated, "the extent to which our results generalize to the United States as a whole is therefore unclear."[3]
According to the most recent (2014) estimates from the Centers for Disease Control, mortality rates nationwide vary from a high of 1,199 deaths per 100,000 people in West Virginia to a low of 560.3 deaths in Alaska.[8] Therefore, applying a mortality rate estimate from one state to all states is a flawed method.
The Massachusetts study researchers also noted that they did not take into account other factors that could have contributed to a decrease in the mortality rate in the state relative to control counties, such as how the state was impacted by the recession.[3]
In addition to the problems associated with generalizing the Massachusetts study’s calculation to a national estimate of newly uninsured, the Urban Institute’s national estimate is based largely on two assumptions: that repealed provisions of the ACA will not be replaced by alternatives that enable people to regain coverage and that individuals will not find coverage alternatives of their own.[2]
Conclusion
In a recent column in Think Progress, Ian Millhiser cited two studies in claiming that “Nearly 36,000 people could die every year, year after year, if the incoming president signs legislation repealing the Affordable Care Act.”
Millhiser’s assertion is not backed up by the studies he used. The limitations of the research methodologies preclude them as a basis for a reliable estimate of how many people may die due to a partial repeal of the ACA.
See also
- Federal policy on healthcare, 2017-2020
- Fact check/Are there places where a single insurer is offering coverage through ACA exchanges?
- Fact check/Have most ACA exchange customers chosen bronze or silver plans?
- Alternative proposals to the Affordable Care Act (Obamacare)
Sources and Notes
- ↑ Think Progress, “Here’s how many people could die every year if Obamacare is repealed,” December 7, 2016
- ↑ 2.0 2.1 2.2 2.3 Urban Institute, “Implications of Partial Repeal of the ACA through Reconciliation,” December 2016
- ↑ 3.0 3.1 3.2 3.3 3.4 Annals of Internal Medicine, “Changes in Mortality After Massachusetts Health Care Reform,” May 6, 2014
- ↑ Congressional Research Service, “Legislative Actions to Repeal, Defund, or Delay the Affordable Care Act,” November 30, 2016
- ↑ United States Senate, “S. Con. Res.” accessed January 6, 2017
- ↑ Center for American Progress, “Ian Millhiser,” accessed January 18. 2017
- ↑ The 190th General Court of the Commonwealth of Massachusetts, “Chapter 58: An Act Providing Access to Affordable, Quality, Accountable Health Care,” accessed January 10, 2017
- ↑ National Vital Statistics Report, “Deaths: Final Data for 2014,” June 30, 2016
Launched in October 2015 and active through October 2018, Fact Check by Ballotpedia examined claims made by elected officials, political appointees, and political candidates at the federal, state, and local levels. We evaluated claims made by politicians of all backgrounds and affiliations, subjecting them to the same objective and neutral examination process. As of 2025, Ballotpedia staff periodically review these articles to revaluate and reaffirm our conclusions. Please email us with questions, comments, or concerns about these articles. To learn more about fact-checking, click here.
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