America’s Healthcare Crisis: Healthy Working Americans Can No Longer Afford Healthcare
Since 2016, healthcare costs are up 400% and working Americans are angry at Obama and Biden for bankrupting the healthcare system and collapsing the emergency room services with criminal immigration from 40 nations.
15 years, millions of working-age Americans have at various times gone without health insurance or remained seriously underinsured because comprehensive coverage, deductibles, prescriptions, and out-of-pocket healthcare costs were simply too expensive.
The consequences are not merely financial. People without affordable coverage may postpone physical examinations, cancer screenings, cardiovascular testing, diagnostic procedures, prescription drugs, and routine treatment until relatively manageable illnesses become medical emergencies.
This raises a disturbing question: How many Americans are dying because they cannot afford timely healthcare? [i]
The Mortality Cost of Being Uninsured
The mortality implications deserve far more attention. Research cited in my earlier analysis estimated approximately 45,000 deaths annually associated with lack of health-insurance coverage. My research also cited a 2022 Gallup survey finding that nearly 40% of Americans skipped or delayed medical care because of cost concerns. The underlying citations included research reported by the Harvard Gazette concerning approximately 45,000 annual deaths associated with lack of health coverage.
That is critical because insurance itself is only part of the equation. A person can technically be insured but still be unable to afford a $5,000 deductible, repeated specialist visits, expensive diagnostic tests or necessary medications.
For working families, underinsurance can therefore become almost as important as uninsurance.
COVID Exposed the Weakness of the System
COVID-19 dramatically exposed these weaknesses.
Millions of Americans experienced employment disruptions during the pandemic, demonstrating the vulnerability of tying health insurance so closely to employment. Waldman’s analysis similarly argues that expanded ACA subsidies and Medicaid during the pandemic protected many consumers from feeling the full cost of escalating insurance premiums without solving the underlying affordability problem.
Most strikingly, a Families USA analysis estimated that approximately 143,000 of the first 437,000 American COVID deaths were associated with health-insurance gaps—approximately 33%, or one out of every three deaths. [ii]
That does not mean that every one of those 143,000 deceased Americans personally lacked an insurance card. The study examined the broader relationship between community insurance gaps and COVID mortality. But its conclusion raises a profound public-policy question about the relationship between affordable healthcare access and survival during a national medical emergency.
If the approximately 33% relationship observed during the first year of COVID were ultimately found to have persisted throughout the pandemic, applying it to roughly 1.2 million American COVID deaths would imply approximately 400,000 deaths associated with health-insurance gaps.
That 400,000 figure is an extrapolation rather than an official death count. Nevertheless, the documented first-year 33% estimate makes the larger question impossible to dismiss.
Healthy Workers Are Being Priced Out
This problem predates COVID.
My earlier research argued that Obamacare’s broad insurance mandates require healthy people to purchase coverage substantially more comprehensive—and expensive—than many younger consumers believe they need. Healthy participants are simultaneously placed into insurance pools supporting people with substantially greater medical expenses.
This creates a perverse economic incentive.
A healthy 25-, 35-, or 45-year-old worker may look at thousands of dollars in annual premiums, followed by thousands more in potential deductibles, and reasonably ask why he should spend such an enormous percentage of his income on insurance he rarely uses.
Some consequently go without comprehensive coverage.
Then they get sick.
And the emergency room becomes America’s healthcare provider of last resort.
Emergency Rooms Were Supposed to Become Less Crowded
One of Obamacare’s original premises was that expanding insurance would reduce emergency-room utilization by moving people into primary and preventive care. My earlier research argued that this expectation has not materialized as intended.
If comprehensive insurance remains unaffordable to healthy workers, some will inevitably postpone ordinary care. A minor medical condition becomes serious. Undiagnosed cardiovascular disease becomes a heart attack. Untreated hypertension becomes a stroke. Cancer discovered late requires vastly more expensive treatment than cancer discovered early.
Eventually some of these people arrive in emergency departments.
Meanwhile, America’s recent immigration surge has created another source of demand on safety-net hospitals. My earlier research cited reporting that Denver Health experienced substantially increased emergency-room utilization associated with the migrant influx.
Whatever one’s immigration politics, hospitals operate under basic laws of supply and demand. Millions of additional people require doctors, nurses, hospital beds, emergency departments, medications, diagnostic equipment and primary-care facilities. If medical capacity does not expand proportionately with population and demand, existing patients—including American citizens and working families—face greater competition for finite healthcare resources.
Colorado Illustrates the Problem
Colorado provides a particularly useful example. Colorado has historically ranked among America’s healthier and leaner populations. Yet ACA-compliant individual insurance generally cannot substantially reward an exceptionally healthy Coloradan through conventional health-status underwriting.
A healthy Coloradan does not necessarily pay the identical dollar premium as an unhealthy resident of New York, Philadelphia, Baltimore or another major East Coast city because geographic rating differences exist.
But the underlying economic problem remains: being substantially healthier does not necessarily produce the dramatically lower insurance premium that conventional individualized risk pricing might suggest.
The young worker who exercises, maintains a healthy weight, doesn’t smoke and rarely sees a doctor therefore helps finance a risk pool containing people requiring dramatically more healthcare.
That may be socially desirable as risk sharing, but policymakers should acknowledge its economic consequence: insurance becomes more expensive for the healthy people needed to keep the insurance pool financially viable.
Healthcare Costs Have More Than Quadrupled
The financial numbers are extraordinary.
Waldman’s analysis reports that consumer health-insurance costs have more than quadrupled over approximately 25 years, with annual increases commonly running between 6% and 9%. Another 9.5% increase is projected for the coming year.
For a family of four, Waldman estimates healthcare costs of approximately $37,824, compared with $83,730 in gross take-home pay.
Government subsidies can disguise these increases to the individual consumer, but they cannot make the underlying expense disappear. Someone still pays.
Waldman argues that ACA subsidies have insulated consumers from part of the escalation in insurance prices while shifting those costs toward taxpayers. My earlier research similarly noted that approximately four out of five HealthCare.gov purchasers could obtain insurance for $10 or less per month after subsidies.
The subsidized premium, however, is not the actual economic cost of providing the insurance.
The Working Class and Immigration – The Strain of Resources
About 60% of American adults now identify as working class, according to recent Pew Research Center polling. [iii] Trump won the union and working-class voters in 2024, in part, from Trump’s policies aimed directly at workers, including tax relief for overtime and Social Security income, as well as expanded deductions affecting truck drivers, farmers, musicians, artists, teachers, union workers, and other working Americans.
Meanwhile, working class Americans see immigration hurting women and minorities the most with approximately 59% of working-class Americans view immigration as a burden on local communities and resouces due to its strain on local schools, hospitals, public assistance, infrastructure and services. [iv]
The Real Healthcare Crisis Is Affordability
This is why America’s healthcare debate asks the wrong question when it focuses exclusively on how many people possess insurance.
The more important question is:
Can ordinary working Americans afford to use healthcare?
A worker with an insurance card but a deductible he cannot afford may postpone exactly the same preventive examination as someone without insurance. A mother who cannot afford a diagnostic test may wait. A middle-aged worker who cannot afford repeated cardiology appointments may hope his symptoms disappear. A family struggling with rent, groceries, gasoline and insurance premiums may postpone preventive medicine because there simply isn’t enough money. Eventually some of those delayed medical problems become emergencies—and some become deaths.
We already have research associating lack of insurance with tens of thousands of deaths annually. We have evidence that nearly 40% of Americans have delayed or skipped healthcare because of cost. And during the first year of COVID, one analysis associated health-insurance gaps with approximately 33% of American COVID deaths.
Those findings justify much deeper research into whether America’s healthcare-financing structure contributes to tens of thousands—and potentially considerably more—preventable deaths in particularly severe years.
The precise number requires rigorous epidemiological analysis. But the underlying mechanism is straightforward:
Unaffordable insurance leads some people to go uninsured or underinsured. Unaffordable healthcare causes some people to postpone preventive medicine. Delayed diagnosis allows some diseases to progress. Advanced disease drives people into already strained emergency departments. And some people inevitably die who might have survived with affordable, timely medical care.
That should be the real test of American healthcare reform. Not how many insurance cards Washington can distribute.
Not how large the subsidies become. Not how many regulations government can impose.
But whether the healthy American worker who gets up every morning, goes to work, pays taxes and supports a family can afford a doctor, preventive medicine, prescriptions, catastrophic protection and medical treatment when needed.
Healthcare is not affordable merely because government calls an insurance program “affordable.” It is affordable only when working Americans can actually afford to use it.
[i] A Critical Analysis of Obamacare Failures | Newsmax.com
[ii] Health Insurance Costs Are Soaring. Here’s Why | The American Spectator | USA News and Politics
[iii] Which Americans see themselves as working class? | Pew Research Center
[iv] A Nation of Immigrants? Diverging Perceptions of Immigrants Increasingly Marking Partisan Divides – PRRI
