Why health reform's demographic split is costing lives

For those hospital finance executives who like to keep up on the demographics of the patients they treat, there was an eyebrow-raising study recently published in Health Affairs: Life expectancies in this country, particularly among undereducated whites, are in decline.

Education played a significant factor. If you're white and male, your lifespan at the age of 25 in 2008 was nearly 13 years longer if you graduated from college compared to those who dropped out of high school. Among white females, the differential was about 10.4 years.

More shocking, however, was the fact that life spans among white female high school dropouts declined five years between 1990 and 2008. For white male dropouts, they lost about three years.

Researchers have puzzled about this lifespan decline. They have credited a variety of factors, including larger number of single parents among women and the rise of prescription drug overdoses.

However, the biggest single factor is almost certainly who has access to healthcare services, which is directly tied into the rates of insured. In the early 1990s, nearly two-thirds of those whites without a high school diploma had health insurance. That declined to slightly more than half in the years leading up to the Great Recession. I am certain it has dropped since.

Ironically, this same group of people has been reluctant to embrace the Patient Protection and Affordable Care Act. All the polling on the ACA has shown that whites--particularly those who have low and moderate incomes and less than a college degree--are disdainful about reform at best.

Only 37 percent of whites approved of the ACA, according to the Pew Research Center, compared to 83 percent of African-Americans and 66 percent of Latinos. And among those with a high school diploma or less, 46 percent approved of the ACA, compared to 45 percent who disapproved. By comparison, 52 percent of those with a college degree or better approved of reform. These demographic splits were repeated in a variety of polls I examined.

There are a number of explanations for this. Among them are the despicable disinformation campaigns practiced by those opposed to the ACA, which is more likely to have an impact on those who obtain their news in sound bites rather than, say, read Health Affairs. There also is the rise of the Tea Party, which has been championed by working and lower middle-class whites.

However, the results have been nothing short of tragic: A group of people are passionately against their own self-interest, even as it is likely costing them years from their lives.

As the nation's hospitals and their state and national associations continue to lobby for Medicaid expansion and the construction of the health exchanges as part of ACA, this should be a talking point. These are many of the same people who have been flooding your emergency rooms for years without health insurance or any ability to pay--the same people Mitt Romney insisted recently on "60 Minutes" should continue to access the system in this exact same manner, with no preventative services and no hope to pay for their care. If you don't speak up, they will. - Ron (@FierceHealth)

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