Is the Affordable Care Act (ACA) a “job killer” for the American economy? It’s been a topic of heated debate, and an important fringe of the population seems convinced that it is. Republicans have presented daunting figures: 2.5 million job losses by 2024 because of ACA. According to them, “Obamacare” would deter people from working to obtain insurance coverage, creating a global shift from full-time to part-time workers. Worse, others speculate that components of ACA would provoke an additional loss of 500,000 jobs: Forbes contributor Chris Conover suggested, for example, that the Medical Device Tax—a 2.3 percent tax on gross revenues for medical device manufacturers—would result in direct and indirect employment reductions.
The White House has rebutted these attacks, stating that the ACA will reduce unemployment and has already created 6.5 million full-time jobs since it launched in October 2013.
Putting aside the fact that the ACA will strongly impact the lives of millions by securing their access to health insurance, debating the community cost of ACA is fair and important. The new health care system will certainly have an effect on employment. It’s also true that unemployment—existing or new—has a huge impact on health and a real associated cost.
Indeed, many scientific studies show that involuntary joblessness contributes to poor mental and physical health conditions. Health Care Policy researchers such as Ronald Kessler through a community survey in Michigan and Robert L. Jin in Canada have been examining the effects of long-term unemployment. Both have shown that unemployment generates chronic stress and unhealthy habits such as smoking and substance abuse, as well as increasing the risk of cardiovascular and heart diseases, high blood pressure, and diabetes.
Dr. Gordon Waddell, a consultant to the British Department of Health, has been studying the connection between jobs and well-being in the UK; he has demonstrated that long-term unemployment increases people’s risk of suffering poor general and mental health by two or three times, and increases mortality rates by 20 percent. And a recent study on DNA by the Imperial College of London shows that the long-term unemployed are twice as likely to have shorter telomeres (structures protecting genetic code from degrading, or becoming shorter over time) as employed people of the same age—in short, this means that unemployed people tend to age faster and are therefore more vulnerable to age-related diseases. All these damaging effects, of course, translate to very real costs (emergency rooms, medical treatments, prescription drugs, and so on) are supported by the whole community.
The good news is that reemployment can reverse these negative effects. Work contributes to mental and physical well-being, and tends to reduce the occurrence of mental illness, substance abuse, and social isolation. According to Waddell, the improvement of health with reemployment is “more or less” comparable to the reverse effects from job loss.
ACA may or may not significantly impact the number of jobs available in the United States. But what is certain is that there are still more than 4 million long-term unemployed people excluded from the labor market, and helping these individuals reach their full potential will have a huge effect on health care.
Social enterprises like my own are already tackling long-term unemployment with job inclusion programs that provide professional training and experiences, paid apprenticeship, and case management to unemployed people. This support helps beneficiaries add valuable experience to their résumés, find adequate jobs, and in turn, improve their health.
In addition to impact investment and foundation funding, we need a wider commitment from the community to support these job inclusion programs. Various public and private actors, including insurance companies and accountable care organizations, would do well to invest now in job inclusion by supporting workforce development enterprises, rather than pay the greater cost of unemployment-related health damages down the line.
America has decided to invest in health care. Good. But if we want to positively impact people’s lives and be cost-efficient, let’s invest in jobs at the same time.