Republican presidential nominee Mitt Romney told the Columbus Dispatch yesterday that “we don’t have people that become ill, who die in their apartment because they don’t have insurance.” “We don’t have a setting across this country where if you don’t have insurance, we just say to you, ‘Tough luck, you’re going to die when you have your heart attack,’ ” he told the newspaper’s editorial board. “No, you go to the hospital, you get treated, you get care, and it’s paid for, either by charity, the government or by the hospital.”
Here’s what the medical literature says about insurance coverage and its impact on mortality (see Factcheck.org):
• A 1993 examination of 1971 through 1987 data on 25- to 74-year-olds from the National Health and Nutrition Examination Survey found a 25 percent higher risk of mortality for the uninsured compared with the insured, after adjusting for various factors, such as age, smoking, alcohol consumption, obesity, education and income. The study, by lead researcher Peter Franks, was published in the Journal of the American Medical Association.
• In 2002, the Institute of Medicine, basing its work on the Franks study and another examining Current Population Survey data, found that 18,000 people (age 25 to 64) died because they lacked health insurance in 2000. (Ayanian added in his testimony that for those with heart disease or cancer and without health insurance, the risk of death for the uninsured could be 40 percent to 50 percent higher.)
• In 2008, the Urban Institute updated the IOM numbers, using later Census Bureau estimates on the uninsured. It found that in 2006, the number who died because of a lack of insurance was 22,000. The Urban Institute also said that the IOM figure "may have underestimated the number of deaths" by trying to calculate different mortality-rate differences for each age group, an approach the Urban Institute said wasn’t well grounded in the research. Applying a mortality-rate difference to the entire population under study produced an even higher number, 27,000.
• The latest report by Harvard researchers used the methodology of IOM but more recent data. It found that the uninsured are 40 percent more likely to die prematurely. And it expanded the age group a bit, estimating that among adults age 18 to 64, there were 35,327 deaths linked to a lack of insurance in 2005. Calculating the estimate without a breakdown by age group increased the figure to 44,789.
• A 2007 report published in the Journal of General Internal Medicine examined data for adults age 45 to 64 from the Atherosclerosis Risk in Communities Study, sponsored by the National Heart, Lung and Blood Institute, finding that the uninsured had a 26 percent higher mortality.
• A 2004 study published in the journal Health Affairs looked at data for those age 55 to 64 in the Health and Retirement Survey. It controlled for socioeconomic factors and found the uninsured in the group had a 3 percent higher risk of dying over an eight-year period. The study called uninsurance the third leading cause of death for that age group, saying that more than 13,000 yearly deaths "may be attributable to the present lack of insurance coverage among the near-elderly."