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?


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