The Effect of Health Insurance on Mortality: What Can We Learn from the Affordable Care Act Coverage Expansions?

The Affordable Care Act’s Effects on Patients, Providers and the Economy: What We’ve Learned So Far

“…Indeed, Black and colleagues argue that the ACA itself is underpowered to detect any mortality effects at the population level, given that coverage gains occurred in all states, and pre-ACA trends may preclude using the Medicaid expansion as an identification strategy for this outcome. 74 A recent working paper by Miller and Wherry challenges this characterization by matching a large sample of survey data with administrative death records. They find no differential pre-trends across expansion and non-expansion states and are able to estimate a precise 8% decline in mortality in the expansion states; they confirm their findings by showing no mortality changes among those over age 65 who should have been unaffected.…”

Did the ACA Medicaid Expansion Save Lives?

“…While the short followup period limits our ability to estimate the long-run effects of health insurance coverage, recent changes in Medicaid, the individual mandate, and other elements of the ACA suggest that the 1 There is extensive evidence pertaining to these outcomes: Currie and Gruber (1996a,b); Card and Shore-Sheppard (2004); Long, Coughlin and King (2005); Finkelstein et al (2012); DeLeire et al (2013); Sommers, Kenney and Epstein (2014); Taubman et al (2014). 2 The effects of Medicaid on adult health and mortality have been examined in Finkelstein et al (2012); Baicker et al (2013), Sommers (2017), Goodman-Bacon (2018), Wherry and Miller (2019), and Black et al (2019). The lack of health insurance is associated with worse health and higher mortality (Wilper et al, 2009), but causality is not clear (Kronick (2009); Black et al (2017)).…”

Medicaid: What Does It Do, and Can We Do It Better?

“…A recent study by Black et al (2018) also finds no evidence that ACA expansions have changed mortality for nonelderly adults. they comment, however, that their estimated confidence intervals are large and that even the national natural experiment of the ACA is underpowered to find effects on mortality of the size that one might expect given past research on the relationship between medical care and shorter-term mortality changes in nondisabled adults.…”