Other Views: Rock County poised to get sicker

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John Spangler
Saturday, December 2, 2017

Rock County—the home county of House Speaker Paul Ryan—is poised to get a lot sicker. This is because the House and Senate proposed tax bills would repeal the Affordable Care Act’s (aka, Obamacare’s) individual mandate.

In turn, this will increase the number of uninsured adults nationally—including Wisconsin and all its counties.

I am both a family physician and a public health researcher. Wearing my research hat, I evaluate county and state disease rates nationwide.

Using publicly available data from the Robert Woods Johnson Foundation and from state health departments, I carry out regression modeling to predict populations’ ill-health. This technique accounts for county demographic differences while weeding out non-significant factors. This leaves only variables statistically tied to increased disease and death.

Since Speaker Ryan holds dramatic sway in Obamacare’s success or failure, I recently scrutinized death rates in his county and state.

In brief, my analysis predicts that death from heart disease, congenital malformations, colon cancer and breast cancer will increase as counties’ uninsured rates increase.

Specifically, for each 1-percent increase in Wisconsin counties’ uninsured adult rates, deaths from heart disease, malformations, breast cancer and colon cancer would increase respectively by 3.6, 0.15, 0.66 and 0.44 per 100,000 people of each Wisconsin county.

Applying this to Rock County’s 2015 population (160,727) that would be about 8 more deaths for each 1 percent increase; for the state’s 5.8 million people, about 280 more deaths.

Under Obamacare, Wisconsin’s uninsured rate dropped 3.7 percent between 2010 and 2015, from 9.4 percent to 5.7 percent. Let’s say Obamacare’s reversal would increase the uninsured rate by the same amount.

This 3.7 percent increase would annually yield about 30 more Rock County and 1,036 more statewide deaths from just these four causes—without even counting all other disease deaths.

That’s about the size of a typical classroom and a typical high school. If a tornado suddenly killed 1,036 people in a community, it would be a catastrophe. Sadly, this many deaths would occur—silently, covertly—every year.

As a family physician, I work to prevent such deaths daily. This involves counseling patients on healthy eating, providing them regular cancer screening, controlling patients’ blood pressure and cholesterol levels, and helping them quit smoking, manage their weight and moderate their alcohol intake.

But prevention requires regular doctor visits, and regular visits are unaffordable for most people without health insurance.

How can uninsured people get health insurance? Through Obamacare.

Since 2010, about 211,000 Wisconsinites have signed up for this program’s insurance plans, and uninsured rates dropped.

Regrettably, even more is at stake than illness and death related to worsening uninsured rates.

Doctor visits would be more expensive even with health insurance because Obamacare’s individual mandate puts more healthy people into the risk pool.

Obamacare would likely collapse.

Thus, free preventive services would disappear. About 2.5 million Wisconsinites would again face pre-existing condition labeling, preventing coverage.

Wisconsin Medicare beneficiaries could lose the $1,000 donut-hole support. And 75 percent of Medicare beneficiaries could lose free preventive services.

Many in our counties, states and nation are already sick. With collapse of the Affordable Care Act’s individual mandate, we could all become a lot sicker.

I hope that’s not what Speaker Ryan wants for Rock County.

Dr. John Spangler is a family physician in Winston-Salem, North Carolina. In addition to seeing family-medicine patients daily, he conducts research on cancer prevention and health policy.

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