Why Didn’t ObamaCare Work?
More evidence that costly government insurance hasn’t made us healthier.
“Life expectancy in the United States fell for the second year in a row in 2016,” NBC News reports this week. The network quotes the government’s National Center for Health Statistics:
“This was the first time life expectancy in the U.S. has declined two years in a row since declines in 1962 and 1963,” the NCHS, part of the Centers for Disease Control and Prevention, said in a statement.This column is not ascribing all of this historically bad news to the former president’s signature accomplishment. Researchers have cited various factors, including trends that began well before Mr. Obama took office. But it’s striking that the implementation of a massive expansion in federal health benefits has coincided with the reversal of a long-term trend of increasing U.S. life expectancy. At a minimum, it should inspire politicians to stop equating rising health appropriations with better health.
Now federal officials are focused on one particular problem as they review the results from 2016. The Journal reports:
Deaths from drug overdoses surged 21% to more than 63,600 in 2016, spurred by widespread black-market availability of deadly synthetic opioids including fentanyl, according to the Centers for Disease Control and Prevention.
Those deaths were the main factor causing life expectancy for Americans born in 2016 to fall to 78.6 years, from 78.7 and 78.9 in the two previous years, CDC officials said.Some scholars have ascribed the declining health of Americans—males in particular—and increasing opioid use on a lack of economic opportunity. Mr. Obama would certainly argue that his predecessors deserve a significant share of the blame on this score.
But lately even people in strong local economies are undergoing dramatic increases in suffering. The enactment of ObamaCare has coincided with a surge of misfortune in states that took the law’s option to expand their Medicaid programs. The Journal’s Allysia Finley noted in September that “government health-care programs are among the biggest suppliers of prescription painkillers.” She added:
Data from the Centers for Disease Control and Prevention show that overdose deaths per capita rose twice as much on average between 2013 and 2015 in states that expanded Medicaid than those that didn’t—for example, 205% in North Dakota, which expanded Medicaid, vs. 18% in South Dakota, which didn’t. That’s particularly striking since the energy boom boosted North Dakota’s economy and employment.
ObamaCare defenders note that the disparity in overdose fatalities appears to have begun around 2010—but due largely to sharp increases in a few expansion states, most notably West Virginia. What’s more, the disaggregated data show that the disparity between expansion and nonexpansion states with similar demographics and geography increased markedly after 2013. Between 2010 and 2013, overdose deaths rose by 28% in Ohio and 36% in Wisconsin. Between 2013 and 2015, they climbed 39% in Ohio, which expanded Medicaid, but only 2% in Wisconsin, which did not.Why does Medicaid expansion correlate with more opioid tragedies? Wrote Ms. Finley:
For one, Medicaid patients may be more likely to be prescribed opioids—twice as likely, according to two studies, as privately insured individuals. A recent study by Express Scripts Holding found that about a quarter of Medicaid patients were prescribed an opioid in 2015.
State Medicaid programs also favor generics over more expensive branded painkillers with abuse-deterrent formulas. According to the Express Scripts study, generics accounted for 90% of Medicaid opioid medication claims. Large doses of oxycodone, methadone and fentanyl can be obtained cheaply with a Medicaid card and resold for a nice profit on the black market.So maybe ObamaCare isn’t making us healthier, but is it at least making health care more affordable? The promise to restrain costs was so central to the marketing of ObamaCare that its formal title is the “Affordable Care Act.” But 2016 marked the third straight year in which U.S. health-care spending grew faster than the economy. That’s according to the American Enterprise Institute’s Joseph Antos and James Capretta, who write this week in the Journal:
Some defenders of the ACA claim the nation’s health-care spending has slowed since 2010. They compare the nominal growth rate before and after ObamaCare became law. Health spending grew at an average of 5.7% a year from 2003-10 and then slowed to 4.3% from 2010-16.
But this comparison of unadjusted nominal figures is misleading for two reasons. First, inflation has been low the past several years in the wake of the Great Recession. After adjusting for inflation, national health spending grew on average 2.6% a year from 2003-10, compared with 2.7% from 2010-16. Second, the population is growing less rapidly than in the past. A fair comparison would use per capita figures. Real national health spending per person rose on average 1.7% a year from 2003-10, compared with 1.9% from 2010-16.Why hasn’t ObamaCare worked? Given the law’s failure on its own terms, perhaps the better question is why much of it remains on the books almost a year after a change in government.
