# U.S. Life Expectancy Down Second Year in Row (Drugs). No Obamacare Effect? **URL:** \ **Category:** In My Humble Opinion\ **Created:** [December 21, 2017, 3:47pm UTC](https://boards.straightdope.com/t/u-s-life-expectancy-down-second-year-in-row-drugs-no-obamacare-effect/805000 "2017-12-21T15:47:54Z")\ **Posts on this page:** 18\ **Page:** 1
**Author:** ![PastTense](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/pasttense/32/14550_2.png) [@PastTense](https://boards.straightdope.com/u/PastTense)\ **Post date:** [December 21, 2017, 3:47pm UTC](https://boards.straightdope.com/t/u-s-life-expectancy-down-second-year-in-row-drugs-no-obamacare-effect/805000/1 "2017-12-21T15:47:54Z")
> [@](#): > > American life expectancy at birth declined for the second consecutive year in 2016, fueled by a staggering 21 percent rise in the death rate from drug overdoses, the Centers for Disease Control and Prevention reported Thursday. > > The United States has not seen two years of declining life expectancy since 1962 and 1963, when influenza caused an inordinate number of deaths. In 1993, there was a one-year drop during the worst of the AIDS epidemic. > **[Fueled by drug crisis, U.S. life expectancy declines for a second straight year](https://www.washingtonpost.com/national/health-science/fueled-by-drug-crisis-us-life-expectancy-declines-for-a-second-straight-year/2017/12/20/2e3f8dea-e596-11e7-ab50-621fe0588340_story.html)** > > Overdose deaths soared to more than 63,000 in 2016, most of those from opioids. But on the other hand: > [@](#): > > The ACA’s major provisions came into force in 2014. By 2016, the uninsured share of the population had roughly halved, with estimates ranging from 20–24 million additional people covered during 2016. > **[Affordable Care Act](https://en.wikipedia.org/wiki/Patient_Protection_and_Affordable_Care_Act)** > > The Affordable Care Act (ACA), formally known as the Patient Protection and Affordable Care Act (PPACA) and colloquially as Obamacare, is a landmark U.S. federal statute enacted by the 111th United States Congress and signed into law by President Barack Obama on March 23, 2010. Together with the Health Care and Education Reconciliation Act of 2010 amendment, it represents the U.S. healthcare system's most significant regulatory overhaul and expansion of coverage since the enactment of Medicar... So why didn’t the implementation of Obamacare save enough lives to dwarf the increase in drug overdoses? [and note Obamacare should have helped with the drug problem too especially with the expansion of Medicaid.] ---
**Author:** ![OldGuy](https://avatars.discourse-cdn.com/v4/letter/o/3bc359/32.png) [@OldGuy](https://boards.straightdope.com/u/OldGuy)\ **Post date:** [December 21, 2017, 4:00pm UTC](https://boards.straightdope.com/t/u-s-life-expectancy-down-second-year-in-row-drugs-no-obamacare-effect/805000/2 "2017-12-21T16:00:42Z")
It’s not clear to me why you think the Affordable Care Act should have helped with the drug overdose problem. But to answer your question, I suspect that the primary benefits of the Act were long-term health care benefits. Getting people to have regular check-ups means you’re going to find those cancers or heart problems which will kill you in five to ten years. Those effects wouldn’t be showing up yet in life expectancy calculations which are not based on how long we expect people to live but on how long people have and are living. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [December 21, 2017, 5:08pm UTC](https://boards.straightdope.com/t/u-s-life-expectancy-down-second-year-in-row-drugs-no-obamacare-effect/805000/3 "2017-12-21T17:08:22Z")
Most Americans who die are on Medicare. Something like 85% of people born will live to age 65, which is the Medicare enrollment age, so their deaths aren’t going to be impacted by the aca much. Also eliminating major causes of death doesn’t impact life expectancy much. Elimination of all forms of cancer will only add up to 3 years to life expectancy. Also people who od lose a ton of years. A cure for cancer may add 2 years life expectancy to 30 people. But an od on fentanyl at age 21 will take 60 years off one person. So it evens out. Basically, Obamacare isn’t going to stop people from oding on fentanyl. That’s what caused this. Also despair among middle age people is causing a surge in alcoholism too which the aca can’t do much about. ---
**Author:** ![up\_the\_junction](https://avatars.discourse-cdn.com/v4/letter/u/f1d935/32.png) [@up\_the\_junction](https://boards.straightdope.com/u/up_the_junction)\ **Post date:** [December 21, 2017, 7:35pm UTC](https://boards.straightdope.com/t/u-s-life-expectancy-down-second-year-in-row-drugs-no-obamacare-effect/805000/4 "2017-12-21T19:35:45Z")
Dudes, Canadians live three years longer - and the gap is growing. Sure, opioids are part of the story but it isn’t the whole. You really need to look at the breakdowns - by ethnicity and State. There’s a 20 year difference between best and worst average life expectancy. ---
**Author:** ![monstro](https://avatars.discourse-cdn.com/v4/letter/m/ba9def/32.png) [@monstro](https://boards.straightdope.com/u/monstro)\ **Post date:** [December 21, 2017, 7:54pm UTC](https://boards.straightdope.com/t/u-s-life-expectancy-down-second-year-in-row-drugs-no-obamacare-effect/805000/5 "2017-12-21T19:54:27Z")
For us to say there is no Obamacare effect, we’d have to look at the alternative universe where everything is the same as this one except for no Obamacare. In other words, Obamacare may be keeping life expectancy from being even lower. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [December 21, 2017, 7:57pm UTC](https://boards.straightdope.com/t/u-s-life-expectancy-down-second-year-in-row-drugs-no-obamacare-effect/805000/6 "2017-12-21T19:57:29Z")
The question the OP asked is if ACA is so great, why did a relatively small number of deaths reduce life expectancy more than ACA raised it? The answer is pretty simple, actually. Health care delivery systems are a very tiny factor in life expectancy. you can’t tell whether a program is good or bad based on that one stat. Cancer survival rates are far more significant, as is infant mortality. But overall life expectancy has more to do with lifestyle and public health(clean water, clean air, etc.) than access to health care. ---
**Author:** ![asahi](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/asahi/32/8693_2.png) [@asahi](https://boards.straightdope.com/u/asahi)\ **Post date:** [December 21, 2017, 8:13pm UTC](https://boards.straightdope.com/t/u-s-life-expectancy-down-second-year-in-row-drugs-no-obamacare-effect/805000/7 "2017-12-21T20:13:56Z")
> [@adaher](#): > > The question the OP asked is if ACA is so great, why did a relatively small number of deaths reduce life expectancy more than ACA raised it? > > The answer is pretty simple, actually. Health care delivery systems are a very tiny factor in life expectancy. you can’t tell whether a program is good or bad based on that one stat. Cancer survival rates are far more significant, as is infant mortality. But overall life expectancy has more to do with lifestyle and public health(clean water, clean air, etc.) than access to health care. Moreover, in the case of opioids, which are regarded as a major factor in declining life expectancy, the healthcare system may not only be not helping but also partly to blame for the crisis in the first place. Obamacare doesn’t address the political corruption that impacts the health system and pretty much all of American life. Obamacare only addressed medical coverage - there are many other factors involved in providing access to care. And even so, most of us would agree that Obamacare was a patchwork that was intended to represent only moderate reform, passing just barely over the objections of the corrupt donor class. The bill had to be watered down just to pass in its current form. And again, we’re just talking about having medical coverage and providing at least some access to services. Obamacare does not address historic segregation that has produced parallel communities along racial lines. It doesn’t address the differences in educational and economic incomes. Doesn’t address the great recession which through millions out of work and caused millions to lose their homes and life savings. The OP talks about the decline of America’s life span - we could just as easily be talking about the shocking rises in poverty and homelessness. Somehow I’m guessing these are all related. ---
**Author:** ![Aspidistra](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/aspidistra/32/3894_2.png) [@Aspidistra](https://boards.straightdope.com/u/Aspidistra)\ **Post date:** [December 22, 2017, 12:14am UTC](https://boards.straightdope.com/t/u-s-life-expectancy-down-second-year-in-row-drugs-no-obamacare-effect/805000/8 "2017-12-22T00:14:42Z")
> [@monstro](#): > > For us to say there is no Obamacare effect, we’d have to look at the alternative universe where everything is the same as this one except for no Obamacare. Sadly, that alternative universe may soon be known as “2019” ---
**Author:** ![PastTense](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/pasttense/32/14550_2.png) [@PastTense](https://boards.straightdope.com/u/PastTense)\ **Post date:** [December 22, 2017, 3:21am UTC](https://boards.straightdope.com/t/u-s-life-expectancy-down-second-year-in-row-drugs-no-obamacare-effect/805000/9 "2017-12-22T03:21:32Z")
> [@OldGuy](#): > > It’s not clear to me why you think the Affordable Care Act should have helped with the drug overdose problem. People who overdose have generally used drugs for a while before they overdose. If so one would expect a reasonable percentage would go to drug treatment programs if they could afford it for help. If you are making $8-$15/hour or less with no insurance you certainly can’t afford a $10,000 to $20,000 drug treatment program. But Medicaid and Obamacare would pay for these treatment programs. ---
**Author:** ![kenobi\_65](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kenobi_65/32/13178_2.png) [@kenobi\_65](https://boards.straightdope.com/u/kenobi_65)\ **Post date:** [December 22, 2017, 4:16am UTC](https://boards.straightdope.com/t/u-s-life-expectancy-down-second-year-in-row-drugs-no-obamacare-effect/805000/10 "2017-12-22T04:16:42Z")
> [@PastTense](#): > > People who overdose have generally used drugs for a while before they overdose. If so one would expect a reasonable percentage would go to drug treatment programs if they could afford it for help. If you are making $8-$15/hour or less with no insurance you certainly can’t afford a $10,000 to $20,000 drug treatment program. But Medicaid and Obamacare would pay for these treatment programs. Many lower-income people, particularly those whose income is high enough that they don’t qualify for Medicaid, have opted to not buy an ACA policy. In a number of states (particularly in the South), there’s also the phenomenon of the “[Medicaid Gap](https://en.wikipedia.org/wiki/Medicaid_coverage_gap).” There are subsidies available to help lower-income people pay for their ACA policies, but part of the ACA legislation was an expectation that states would raise their ceiling for Medicaid eligibility, and ACA subsidies were designed to only be available for people whose income was higher than the proposed Medicaid ceiling. The Federal government offered to pay to cover that increase in Medicaid eligibility, but only for a limited number of years, and roughly 18 states opted to not raise their Medicaid ceilings. As a result, there are roughly 3 million people who make too much to qualify for Medicaid, but not enough to qualify for a subsidy to buy an ACA policy. Even if they _want_ to buy health insurance, it’s very likely unaffordable for many of them. In addition to those in the Medicaid gap, there are millions of people who have simply chosen to not buy an ACA policy. Even with subsidies (which many people may not realize are available), ACA policies can be quite expensive, and for a lot of people, the tax penalty for not buying coverage has been considerably less than the cost of the premiums for an ACA policy. ---
**Author:** ![kenobi\_65](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kenobi_65/32/13178_2.png) [@kenobi\_65](https://boards.straightdope.com/u/kenobi_65)\ **Post date:** [December 22, 2017, 4:47am UTC](https://boards.straightdope.com/t/u-s-life-expectancy-down-second-year-in-row-drugs-no-obamacare-effect/805000/11 "2017-12-22T04:47:22Z")
By the way, here’s a table from the Kaiser Family Foundation, on insurance coverage for 2016, both nationally, and by state. > **[Health Insurance Coverage of the Total Population](https://www.kff.org/other/state-indicator/total-population/?currentTimeframe=0&sortModel=%7B%22colId%22%3A%22Location%22%2C%22sort%22%3A%22asc%22%7D)** > > Filling the need for trusted information on national health issues What you can see is that, overall, even after several years of the ACA, 9% of the population is still uninsured. Just for reference, people under age 65 who are buying “individual” (e.g., ACA) policies fall into the “Non-Group” column. The “Other Public” likely includes the CHIP coverage for children. ---
**Author:** ![justanothermike](https://avatars.discourse-cdn.com/v4/letter/j/c2a13f/32.png) [@justanothermike](https://boards.straightdope.com/u/justanothermike)\ **Post date:** [December 22, 2017, 5:37am UTC](https://boards.straightdope.com/t/u-s-life-expectancy-down-second-year-in-row-drugs-no-obamacare-effect/805000/12 "2017-12-22T05:37:54Z")
Because even those with “Affordable” Care (lol) can’t afford to actually use it if they can afford to pay for it. It’s nothing but the “mandatory insurance” act, insurance with high premiums and high deductibles that many likely can’t afford to actually use, though they may have it. 😉 ---
**Author:** ![kenobi\_65](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kenobi_65/32/13178_2.png) [@kenobi\_65](https://boards.straightdope.com/u/kenobi_65)\ **Post date:** [December 22, 2017, 5:45am UTC](https://boards.straightdope.com/t/u-s-life-expectancy-down-second-year-in-row-drugs-no-obamacare-effect/805000/13 "2017-12-22T05:45:12Z")
> [@justanothermike](#): > > Because even those with “Affordable” Care (lol) can’t afford to actually use it if they can afford to pay for it. It’s nothing but the “mandatory insurance” act, insurance with high premiums and high deductibles that many likely can’t afford to actually use, though they may have it. 😉 Indeed so. (Full disclosure: I work in advertising, and my primary client is a large regional health insurance company, which offers ACA policies.) Many ACA policies have high deductibles – that means that, while you’re insured, and you do have access to the rates for doctors and hospitals that your health insurance company has negotiated, you may well have to pay several thousand dollars “out of pocket” yourself before your insurer actually pays anything. I had an ACA policy in 2016 (a “silver” level plan, from Blue Cross and Blue Shield of Illinois), and my annual deductible was $6000 – and that’s not at all atypical for ACA plans. So, in the hypothetical that the OP gave in post #9, about “a $10,000 to $20,000 drug treatment program,”…even if you have an ACA policy, if you haven’t met your deductible for the year, you may be on the hook for several thousand dollars yourself before your insurance company pays anything. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [December 23, 2017, 1:31am UTC](https://boards.straightdope.com/t/u-s-life-expectancy-down-second-year-in-row-drugs-no-obamacare-effect/805000/14 "2017-12-23T01:31:28Z")
While probably not the intent of the Democrats, that is actually better for controlling health care costs. ACA plans are essentially catastrophic coverage plans, only kicking in after several thousand dollars have been paid. That’s how insurance is supposed to work, so they kinda backed into a good policy there. ---
**Author:** ![bb49](https://avatars.discourse-cdn.com/v4/letter/b/b38774/32.png) [@bb49](https://boards.straightdope.com/u/bb49)\ **Post date:** [December 23, 2017, 10:47pm UTC](https://boards.straightdope.com/t/u-s-life-expectancy-down-second-year-in-row-drugs-no-obamacare-effect/805000/15 "2017-12-23T22:47:52Z")
The numbers I could find are for 2015 and they show deaths caused by drug use to be about 7% of all deaths in the USA. Btw, at 7% the USA is third highest in the world. And yes, overdoes are becoming more common so that number will be higher for 2016 and 2017. Fentanyl is probably the biggest culprit in these increase. We have had a huge increase in fentynal related deaths in Canada too, so I doubt Obamacare can be blamed. Btw, the number one cause of death in the USA is coronary heart disease, the USA ranks at 107 worldwide, and the number two cause of death in the USA is Alzheimer/dementia and the USA is #2 ranked in the world with this. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [December 24, 2017, 12:44am UTC](https://boards.straightdope.com/t/u-s-life-expectancy-down-second-year-in-row-drugs-no-obamacare-effect/805000/16 "2017-12-24T00:44:03Z")
Piling on maybe but in addition to life expectancy changes being in any case a lagging indicator of health care quality, it must be emphasized that the ACA was a half measure that was better than none but not one that can completely offset the impacts of increasing wealth inequality. [A good article here](https://www.theguardian.com/inequality/2017/may/08/life-expectancy-gap-rich-poor-us-regions-more-than-20-years). > [@](#): > > … Analysis of county-by-county statistics allowed the study team to identify the areas of greatest inequality and incorporate their findings into a colour-coded map of the US, where counties in which life expectancy at birth is low are shaded in red, and those with longer expectations are blue. > > As well as the pockets in the Dakotas, swaths of dark red are particularly prevalent in rural western Mississippi, eastern Kentucky and southwestern West Virginia – areas that are all considered to be generally economically challenged. > > Meanwhile, the darkest blue covers most of central Colorado, western Wyoming and Texas, the majority of the coastal counties of California and southwestern Florida, with a concentration also seen in southern Minnesota. > > According to Mokdad, the ongoing wrangling in the US Congress over health insurance reform perfectly showcases one of the factors cited for the inequality. “Many people don’t have health insurance, but even among those who do it’s misleading,” he said. > > “My insurance, for example, allows me to go to a doctor for an exam and a blood test and they’ll tell me if I have a problem early on. Many don’t have that luxury, only catastrophic insurance, so if they’re hit by a car they’ll be treated. > > “There are disparities by race, by economy, by geography. In Seattle there’s a good medical centre but if I have a heart attack and I’m two hours away in the mountains, it’s going to take me longer to get good care … ---
**Author:** ![Nava](https://avatars.discourse-cdn.com/v4/letter/n/da6949/32.png) [@Nava](https://boards.straightdope.com/u/Nava)\ **Post date:** [December 24, 2017, 5:04am UTC](https://boards.straightdope.com/t/u-s-life-expectancy-down-second-year-in-row-drugs-no-obamacare-effect/805000/17 "2017-12-24T05:04:29Z")
> [@bb49](#): > > We have had a huge increase in fentynal related deaths in Canada too, so I doubt Obamacare can be blamed. We’re starting to see them in Spain also, as well as a raise in heroin use. Here the main healthcare coverage debate is about what coverage to give to undocumented immigrants (healthcare is managed at the regional level, each region has its issues but that one is nationwide); the term for “working under the table” is _estar sin seguros_, “working with no healthcare coverage”. ---
**Author:** ![CelticKnot](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/celticknot/32/3392_2.png) [@CelticKnot](https://boards.straightdope.com/u/CelticKnot)\ **Post date:** [December 24, 2017, 2:53pm UTC](https://boards.straightdope.com/t/u-s-life-expectancy-down-second-year-in-row-drugs-no-obamacare-effect/805000/18 "2017-12-24T14:53:52Z")
Another factor in discouraging people from buying ACA: In some places, you can buy the very expensive insurance with the very high deductible. Then you discover no one in your community accepts ACA, so you have to drive hours away from home to see a doctor. ACA doesn’t compensate patients for taking a full day off to drive to the big city, or for the travel expenses. Before anyone argues that insurance doesn’t do that, I lived on an island that had no neurologists. My insurance paid for me to fly to the nearest island that did to see the neurologist every 6 months or so.