A study published in the Annals of Internal Medicine yesterday said that after the 2006 “Romneycare” law went into effect in Massachusetts, mortality rates in Massachusetts dropped by about 3 percent.

The study tallied deaths in Massachusetts from 2001 to 2010 and found that the mortality rate — the number of deaths per 100,000 people — fell by about 3 percent in the four years after the law went into effect. The decline was steepest in counties with the highest proportions of poor and previously uninsured people. In contrast, the mortality rate in a control group of counties similar to Massachusetts in other states was largely unchanged.

A national 3 percent decline in mortality among adults under 65 would mean about 17,000 fewer deaths a year.

There have been a number of estimates of how many people die in the U.S. every year because they lack insurance. I think that’s a hard thing to quantify, and some people (Megan McCardle, actually) denied that access to health care made any difference to mortality rates at all, based on some standard McCardle-style reasoning that makes sense only if you don’t think about it.

The estimates have ranged from a low of 18,000 deaths per year to a high of 45,000 (analysis here), and the new study comes closer to supporting the lower figure. However, I postulate that the effects might be larger in poorer states, especially over a longer period of time (the study only covered 2006-2010). I believe Massachusetts already had lower mortality rates than much of the rest of the country, mostly because it is more affluent overall. Also, it’s going to take a few years before the effects of long years of neglect fade away. But they’re not going to fade so much in “Medicaid gap” states.

See also interesting comments from The Incidental Economist.

Meanwhile Gallup reports that the percentage of uninsured Americans has dropped to the lowest point since they began measuring the percentage of uninsured Americans.

Also meanwhile, some whackjob Republican is comparing Obamacare to the Holocaust. And a majority of Americans still think Obamacare is a failure.

Health and Human Services Secretary Kathleen Sebelius resigned yesterday, which the Right heralds as a sign of victory. Some guy at the Federalist already is salivating over the grand fight they’re going to have nominating her replacement —

In any case, it appears that this resignation presents Republicans with a golden opportunity to reignite their crusade against Obamacare with Sylvia Burwell’s nomination as a proxy for all the problems with the law. Burwell is a political loyalist and a veteran of the shutdown fight with no record on health care, and will likely be coached to avoid answering questions about specific challenges with implementation at HHS. Senate Republicans actually have an advantage here in the wake of the Nuclear Option’s implementation: they can easily come up with a list of facts they claim the administration has hidden, details kicked aside, statutes ignored, and a host of other challenging questions on accountability over the implementation (and non-implementation) of the law. A list of every question Sebelius has dodged over the past several years would suffice. By demanding answers before the HHS nomination moves forward and refusing to rubber stamp the president’s pick, Republicans could force more vulnerable Democrats to take a vote that ties them both to the Nuclear Option and Obamacare six months before a critical election.

I understand Rachel Maddow was bothered that the resignation stepped on a week of good news about the ACA. But by November, it may not matter. I do not think most folks give a hoo-haw about the nuclear option, and who knows what public opinion of the ACA will be by November? If Republicans grandstand overmuch over the nomination hearings, they risk overplaying their hand, as they are prone to do.

Krugman writes,

When it comes to health reform, Republicans suffer from delusions of disaster. They know, just know, that the Affordable Care Act is doomed to utter failure, so failure is what they see, never mind the facts on the ground.

Thus, on Tuesday, Mitch McConnell, the Senate minority leader, dismissed the push for pay equity as an attempt to “change the subject from the nightmare of Obamacare”; on the same day, the nonpartisan RAND Corporation released a study estimating “a net gain of 9.3 million in the number of American adults with health insurance coverage from September 2013 to mid-March 2014.” Some nightmare. And the overall gain, including children and those who signed up during the late-March enrollment surge, must be considerably larger.

However, we still have the huge injustice of the refusal to expand Medicaid.

What’s amazing about this wave of rejection is that it appears to be motivated by pure spite. The federal government is prepared to pay for Medicaid expansion, so it would cost the states nothing, and would, in fact, provide an inflow of dollars. The health economist Jonathan Gruber, one of the principal architects of health reform — and normally a very mild-mannered guy — recently summed it up: The Medicaid-rejection states “are willing to sacrifice billions of dollars of injections into their economy in order to punish poor people. It really is just almost awesome in its evilness.” Indeed.

And while supposed Obamacare horror stories keep on turning out to be false, it’s already quite easy to find examples of people who died because their states refused to expand Medicaid. According to one recent study, the death toll from Medicaid rejection is likely to run between 7,000 and 17,000 Americans each year.

There’s your death panels, folks. They’re called “Republican governors.”

In mid-December I was able to make a not-too-rough calculation of what my net income was in 2013, and with that information I got on the New York health insurance exchange website to see what I could get. Granted, the site was getting slammed by then, but beside being slow it was also confusing and badly thought out, I believe.

At one point I had absolutely no idea how to proceed and had to call the help phone number, which turned into its own adventure. At one point I was on hold for 45 minutes, then a real person answered. But she couldn’t hear me and hung up.

I left a message for New York to call me back. The next day I got a call back with a recorded message to stay on the line for the next available representative. Then the call disconnected.

When I finally did get to the page showing my options, I learned I was eligible for a decent subsidy, and with that there are a couple of plans that have considerably lower premiums than what I am paying now. But the website gave me few details, and when I tried to find my doctor in the companies’ networks I got zero.

I have a decent insurance policy that is inexpensive by New York standards, but it’s still a challenge to pay for it. But I decided to pay the old premium one more time so that I’m covered for January and try to make a decision when I have more information. I have since determined that my doctor is indeed in the network of at least one of the companies, so this may be a good deal for me. The new policy would have a higher deductible than my old one, and I have to work out if the difference in premiums would still be a good deal if I have to pay all the deductible, and I haven’t gotten to that yet. But I have hope.

I bring this up because I think there must be a huge backlog of people who are either still stymied by the system or who haven’t even tried because they’ve heard it doesn’t work. I’m pretty comfortable with the Web, you know, so if I had trouble navigating the New York website there must have been a lot of people who were completely defeated. A shame.

Jonathan Cohn writes that the rate of enrollment has picked up dramatically, but it’s still short of Obama Administration projections. “While lower-than-predicted enrollment could be a sign consumers don’t like the new policies, they could also represent the lingering effects of the site’s technical problems,” he says.

I’m betting it’s more the latter than the former, although it’s possible a lot of people thought they were going to get free insurance and were unpleasantly surprised when they learned they had to pay something. (Support single payer!)

And we know now that 5 million people have fallen into the “wingnut hole” — they are eligible for Medicaid but can’t get it because they live in wingnut states.

There is speculation whether someday, before the Apocalypse, Republicans will accept that Obamacare is here to stay and perhaps be willing to negotiate to make it more to their liking. I agree with Kevin Drum —

Medicaid is more than half a century old, and Republicans still aren’t willing to cut deals that might strengthen it in return for some conservative policy advances. In fact, they’re still dead set on block granting Medicaid as a way of slowly starving it to death.

Obamacare could be different if it becomes widely used by the middle class, not just the poor. Republicans would have a hard time resisting middle-class demands to improve the program. But that’s what it will take. And I’d guess that 2017 is about the earliest likely date for Republicans to give up their dream of total repeal.

The thing is, though, Republicans aren’t interested in a law that works better. Ultimately they don’t care if it works or doesn’t work. It’s a government program that helps the less fortunate. That’s all they need to know to be against it.

By now you may have seen this chart showing that about 3 percent of Americans are expected to have to pay a higher premium for insurance next year because of the ACA. This was not unexpected. But I fear the rightie noise machine has pumped it up to a BIG BLEEPING DEAL. See, for example, this Wall Street Journal op ed by a cancer patient whose policy was canceled, and none of her new options will let her see all of her doctors.

That’s very sad. However, it turns out, the cancellation wasn’t because of the ACA.

(Update: Looks like that’s not the only thing the subject of the article left out.)

Sundby shouldn’t blame reform — United Healthcare dropped her coverage because they’ve struggled to compete in California’s individual health care market for years and didn’t want to pay for sicker patients like Sundby.

The company, which only had 8,000 individual policy holders in California out of the two million who participate in the market, announced (along with a second insurer, Aetna) that it would be pulling out of the individual market in May. The company could not compete with Anthem Blue Cross, Blue Shield of California and Kaiser Permanente, who control more than 80 percent of the individual market.

Not that Wall Street Journal readers are likely to find that out.

The Washington Post dutifully reports on the “growing backlash”

Americans who face higher ­insurance costs under President Obama’s health-care law are angrily complaining about “sticker shock,” threatening to become a new political force opposing the law even as the White House struggles to convince other consumers that they will benefit from it.

The growing backlash involves people whose plans are being discontinued because the policies don’t meet the law’s more-stringent standards. They’re finding that many alternative policies come with higher premiums and deductibles.

There aren’t enough of them by themselves to become a “new political force,” of course. What the Washingon Post doesn’t bother to mention, but the New York Times did, is that nobody’s policy was cancelled, strictly speaking, because of the ACA. instead, they were upgraded. A lot of those old “cancelled” policies were junk. (See also.)

Making the “sticker shock” worse, however, is that insurers are hiding benefits from customers and trying to gouge them as well.

Across the country, insurance companies have sent misleading letters to consumers, trying to lock them into the companies’ own, sometimes more expensive health insurance plans rather than let them shop for insurance and tax credits on the Obamacare marketplaces — which could lead to people like Donna spending thousands more for insurance than the law intended. In some cases, mentions of the marketplace in those letters are relegated to a mere footnote, which can be easily overlooked.

The extreme lengths to which some insurance companies are going to hold on to existing customers at higher price, as the Affordable Care Act fundamentally re-orders the individual insurance market, has caught the attention of state insurance regulators.

Making this worse is the fact that a lot of people facing higher premiums can’t get on the website yet to find out what better deals might be out there. So we’re in for a bumpy ride for awhile, I’m afraid.

Update and off topic — Smirking Chimp is holding a fundraiser to help it stay online.