President Trump's no 'dying in the streets' pledge faces reality check



Associated Press

President Donald Trump has often said he doesn't want people "dying in the streets" for lack of health care.

Our US Correspondent says the bill will overhaul healthcare in the US.
Source: Breakfast

But in the United States, where chronic conditions are the major diseases, people decline slowly. Preventive care and routine screening can make a big difference for those at risk for things such as heart problems and cancer, especially over time.

That edge is what doctors and patients fear will be compromised if Republican efforts to repeal the Obama-era health law lead to more uninsured people. The uninsured tend to postpone care until problems break through.

It's a message that lawmakers are hearing from doctors' groups and constituents, in letters and emails, and at town hall meetings.

Stories of health care hardships are swirling around the Senate debate as Majority Leader Mitch McConnell, R-Ky., pushes toward a vote on legislation rolling back much of former President Barack Obama's Affordable Care Act. The GOP bill has been facing headwinds since the Congressional Budget Office estimated it would lead to 22 million more uninsured people by 2026.

Administration officials say the nonpartisan budget office has been wrong before about health coverage, and its analytical methods may give too much weight to the current requirement that most people carry health insurance or risk fines.

Health and Human Services Secretary Tom Price said Trump's goal is more people with health insurance, not fewer.

"Nobody is looking at it in its totality," Price said recently on NBC. "We will bring down premiums, we will increase coverage, we'll increase choices. And I believe we'll increase the quality of care provided in this nation."

There's not much debate about the negative consequences of being uninsured.

Studies by the National Academies have found that the uninsured are more likely to receive too little care, and too late; be sicker and die sooner; and receive poorer care in the hospital.

But surprisingly, there are questions about whether gaining coverage produces tangible health benefits.

Major government surveys have documented clear improvements to family finances associated with Obama's coverage expansion. On health itself, the evidence is mixed.

Medicaid expansions in New York, Maine and Arizona in the early 2000s were associated with a 6 per cent decline in death rates in those states, compared with neighbouring states that did not expand coverage for low-income people. A study of Massachusetts found a similar trend.

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