EDITORIAL: Is Obamacare provision actually killing patients?

Obamacare was back in the news this month when a federal judge in Texas ruled that Barack Obama’s signature achievement was unconstitutional because the law no longer includes the individual mandate forcing Americans to buy health insurance.

The decision generated a slew of media attention and will no doubt be appealed. But lost in the debate was a recently released study which found that one Obamacare program may actually be killing people.

At issue is a provision in the law that penalizes hospitals for pneumonia, heart failure and heart attack patients who are readmitted within a month. Patients who return to the hospital cost Medicare billions of dollars each year, and the penalty was designed to encourage medical centers to more effectively treat such patients, thus lowering readmission rates.

Since 2012, the program has generated nearly $2 billion in hospital fines, Peter Suderman of Reason.com points out, and readmissions have “dropped between 2.3 and 3.6 percentage points for the conditions targeted.” So hospital officials have indeed taken notice.

But the law of unintended consequences is immune to repeal. A study published last week in the Journal of the American Medical Association concluded that “the number of people who died within a month of leaving the hospital,” Mr. Suderman reports, “increased for heart failure patients after the readmission policy was implemented.” Mortality rates for pneumonia also went up.

This tracks with a previous study, Mr. Suderman reveals, which looked at 115,000 Medicare patients and found “that although readmissions for heart failure were down, mortality had increased, with 5,400 more people dying annually.”

It’s harder to be readmitted, of course, when you’re a corpse.

Obviously, there is the matter of cause and effect here. Whether the provision is directly responsible for the increase in deaths remains a matter of debate. But the authors of the JAMA study conclude that the implementation of fines under Obamacare is “significantly associated” with the higher death rate, and that the relationship between the two is “statistically significant.”

Effective Oct. 1, the Centers for Medicare &Medicaid Services moved to mitigate readmission penalties for “safety net” hospitals that serve a high number of low-income patients. The Trump administration agreed that such medical facilities were being disproportionately punished under Obamacare. That’s a good first step.

But the JAMA study calls into question the entire premise behind the readmission fines. It appears that Congress could potentially save thousands of lives each year by re-evaluating the policy.