Here's What Will Happen If Obamacare Is Repealed, According to Two Public Health Professors

Will the Republican effort to repeal the Affordable Care Act actually kill people?

As Republicans make strides in their plan to dismantle the broad ranging health care law, politicians and pundits alike have quibbled over the tangible human cost of the repeal effort.

Citing data from ThinkProgress, Senator Bernie Sanders (I-Vt.) claimed on Twitter that 36,000 people would die if Obamacare was repealed.

The Washington Post's Glenn Kessler disputed Sanders' claim, arguing that the Senator wrongly assumed that taking away insurance from people would hurt them just as much as giving them insurance helped them.

However, on Monday, two public health professors argued in The Washington Post that Sanders' claim may have actually been too conservative, and that repeal could cost the lives of more than 43,000 people.

How did they get to that number?

The biggest and most definitive study of what happens to death rates when Medicaid coverage is expanded, published in the New England Journal of Medicine, found that for every 455 people who gained coverage across several states, one life was saved per year. Applying that figure to even a conservative estimate of 20 million losing coverage in the event of an ACA repeal yields an estimate of 43,956 deaths annually.

Authors David Himmelstein and Steffie Woolhandler took issue with Kessler's fact check of Sanders, arguing that it's not yet certain that Republicans will be able to craft a replacement for Obamacare, never mind one that provides similar level of health care access.

But while repeal seems highly likely (indeed, it’s already underway using a legislative vehicle that requires only 50 Senate votes), replacement (which would require 60 votes) is much less certain.

Moreover, even if a Republican replacement plan comes together, it’s likely to take a big backward step from the gains made by the ACA, covering fewer people with much skimpier plans.

Who is at Risk is Obamacare is repealed?

Dana Goldman, director of the University of Southern California's Schaeffer Center for Health Policy and Economics, told ATTN: that there are certain vulnerable populations that would be immediately affected by losing health insurance.

"What we know about population health is that insurance for certain very vulnerable populations certainly matters," Goldman said. "For the HIV population, access to medication is key to keeping the virus at bay. It's always been the case that insurance has provided that access. The same thing for blood pressure control."

He said that people who suffer from conditions like hypertension tend to be able to control their blood pressure when they're insured, and that their blood pressure often goes out of control when they're not insured.

"There are certain vulnerable populations for whom we know having access to insurance can mean the difference between life and death," Goldman said.