Working Paper: NBER ID: w26081
Authors: Sarah Miller; Norman Johnson; Laura R. Wherry
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 non-expansion 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 non- expanders. 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.
Keywords: Medicaid; Mortality; Affordable Care Act; Health Insurance; Health Disparities
JEL Codes: I11; I13
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| Medicaid enrollment (I18) | mortality rates (I12) |
| Medicaid expansions (I18) | mortality rates (I12) |
| Medicaid expansions (I18) | disease-related deaths (I12) |
| first year post-expansion (N12) | mortality rates (I12) |
| fourth year post-expansion (Y60) | mortality rates (I12) |
| Medicaid expansions (I18) | averted deaths (J17) |