Medicaid and Mortality: New Evidence From Linked Survey and Administrative Data

Abstract

We use large-scale federal survey data linked to administrative death records to investigate the relationship between Medicaid enrollment and mortality. Our analysis compares changes in mortality for near-elderly adults in states with and without Affordable Care Act Medicaid expansions. We identify adults most likely to benefit using survey information on socioeconomic status, citizenship status, and public program participation. We find that, prior to the ACA expansions, mortality rates across expansion and nonexpansion states trended similarly, but beginning in the first year of the policy, there were significant reductions in mortality in states that opted to expand relative to nonexpanders. Individuals in expansion states experienced a 0.132 percentage point decline in annual mortality, a 9.4 percent reduction over the sample mean, as a result of the Medicaid expansions. The effect is driven by a reduction in disease-related deaths and grows over time. A variety of alternative specifications, methods of inference, placebo tests, and sample definitions confirm our main result.

Protocol: Evaluating the Effect of ACA Medicaid Expansion on 2015-2018 Mortality Through Matching and Weighting

“…We then intend to conduct the same analysis but with application of a novel weighting scheme constructed around the proportion of adults newly eligible for Medicaid. This is similar to the work of Miller et al (2019) but deviates in two substantial manners. First, we examine all working-age adults, not merely adults aged 55-64.…”

“…use propensity score pair matching and find that ACA Medicaid expansion had a significant negative effect on mortality between 2014 and 2017 using an ITOT analysis. Miller et al (2019); Khatana et al (2019); Swaminathan et al (2018) all similarly find that ACA Medicaid expansion was associated with decreased mortality among specific populations. On the other hand, do not find significant associations between ACA Medicaid expansion and mortality and find that their studies of the effect of expansion on mortality at the county level are underpowered.…”

“…Studies analyzing particular subgroups found benefits to mortality as well. For example, Miller et al (2019) examined older adults newly eligible for Medicaid as a result of the ACA and discovered decreased mortality and Swaminathan et al (2018) found reductions in mortality among individuals with end-stage renal disease.…”

“…By mid 2014, twenty-five states in the mainland US adopted the expansion (with the expanded eligibility effective January 1, 2014 in most of these states). There is a growing literature on the effect of ACA Medicaid expansion in the US on general health as well as on mortality (see, for example, Miller et al, 2019;Khatana et al, 2019;Swaminathan et al, 2018;.…”

Stabilizing and Strengthening the Affordable Care Act: Opportunities for a New Administration

“…These major coverage expansions, along with other provisions, have reduced the number of uninsured Americans by about 20 million (NCHS 2019) and have led to significant improvements in access to and affordability of care across a wide range of services and populations (Gruber and Sommers 2019;McMorrow and Holahan 2020;McMorrow and Polsky 2016). There is also growing evidence that the law has improved population health and reduced mortality (Allen and Sommers 2019;Goldin, Lurie, and McCubbin 2019;Miller, Johnson, and Wherry 2021) and further improved family financial security (Caswell and Waidman 2017;Hu et al 2018;Zewde et al 2019).…”