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

TLDR

The study investigates how Medicaid enrollment affects mortality using linked federal survey and death record data. The authors compare mortality changes among near‑elderly adults in states with and without ACA Medicaid expansions, using survey data on socioeconomic status, citizenship, and public program participation to identify those most likely to benefit. The study finds that Medicaid expansion under the ACA led to a 0.132‑percentage‑point (9.4%) annual mortality decline, driven by fewer disease‑related deaths, with effects growing over time and confirmed by robustness checks.

Abstract

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% 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.