How a simple letter from the IRS on health coverage saved lives

How a simple letter from the IRS on health coverage saved lives
Royalty-free stock photo ID: 792809188. Woman and man doing paperwork together, paying taxes online on notebook pc

At the end of 2016, during Affordable Care Act open enrollment for 2017, the Internal Revenue Service sent a letter to 3.9 million people who had not signed up for health insurance and who had thus been fined under the ACA. The letter told them how to get coverage, and many of them then did. According to a recent study from three economists in the Treasury Department, it saved as many as 700 lives.


A budgeting error ended up making this study possible; the Obama administration had intended to send letters to 4.5 million people who had paid the fine under the individual mandate, but didn't allocate enough. So 600,000 were randomly left out of the mailing, thus creating a control group for the researchers. What they found, looking specifically at the age group 45-64 which is mostly likely to have chronic condition, is that for every one of the 1,648 people who received the letter, there was one fewer death among them than in the group that didn't get it.

The economists ultimately found that "gaining coverage was associated with a 12 percent decline in mortality over the two-year study period (the first months of coverage seemed to be most important, presumably because people could get caught up on various appointments and treatments they might have been missing)." One of them, Jacob Goldin, who formerly worked at the Treasury said he "was definitely torn about it," when they were unable to send letters to the entire 4.5 billion. "We were hoping the letters would be beneficial, and wanted them to go to everybody. But it was also an exciting research opportunity."

Indeed, one more that demonstrates that having health insurance does indeed save lives. "There has been a lot of skepticism, especially in economics, that health insurance has a mortality impact," said Sarah Miller, an assistant professor at the University of Michigan who was not involved in this study. "It's really important that this is a randomized controlled trial. It's a really high standard of evidence that you can't just dismiss." That's evidence on the role health insurance can play in health.

It's also evidence of the damage the Trump sabotage has done, because just months after the Trump administration cut the budget for outreach and education and assistance in ACA enrollment. "It's an innovation to know that just sending a letter to people with information about what it means to be insured versus uninsured can substantially change coverage rates," said Katherine Baicker, dean of the University of Chicago Harris School of Public Policy. "That is really important, new information."

So how many deaths can be attributed directly to Trump?

Enjoy this piece?

… then let us make a small request. AlterNet’s journalists work tirelessly to counter the traditional corporate media narrative. We’re here seven days a week, 365 days a year. And we’re proud to say that we’ve been bringing you the real, unfiltered news for 20 years—longer than any other progressive news site on the Internet.

It’s through the generosity of our supporters that we’re able to share with you all the underreported news you need to know. Independent journalism is increasingly imperiled; ads alone can’t pay our bills. AlterNet counts on readers like you to support our coverage. Did you enjoy content from David Cay Johnston, Common Dreams, Raw Story and Robert Reich? Opinion from Salon and Jim Hightower? Analysis by The Conversation? Then join the hundreds of readers who have supported AlterNet this year.

Every reader contribution, whatever the amount, makes a tremendous difference. Help ensure AlterNet remains independent long into the future. Support progressive journalism with a one-time contribution to AlterNet, or click here to become a subscriber. Thank you. Click here to donate by check.

Close