Keck School of Medicine of USC
Medicaid Cuts Linked to Worse Health, More Deaths
A new analysis provides evidence that reductions in access to Medicaid could increase deaths and cause financial hardship to people currently covered under an expansion of Medicaid that was implemented under the Affordable Care Act (ACA).
Medicaid is a joint federal and state program that provides health insurance to qualifying individuals who are unable to obtain it through their employer, private insurance companies, or Medicare, the public insurance program for seniors and people with disabilities. About two in five births in the United States are financed by Medicaid, and although it’s not widely known, most people covered by the program have jobs. Funded jointly by the federal government and individual states and administered by state agencies, Medicaid goes by different names in some places, such as Medi-Cal in California or MassHealth in Massachusetts.
Investigators at the Keck School of Medicine of USC , Boston University and the University of Amsterdam in the Netherlands built upon existing research to predict the impacts of potentially reducing the scope of coverage of Medicaid. In a peer-reviewed research letter published in The Lancet , the authors found that reductions in Medicaid coverage or access could lead to thousands of additional deaths among working-age Americans, disastrous financial burden for hundreds of thousands, and delays in necessary care for millions.
“More than 70 million people depend on Medicaid for everything that has to do with their health, whether it’s for preventive care, accidents or surgeries,” said co-senior author Brian P. Lee, MD, an associate professor of clinical medicine at the Keck School of Medicine. “The devastating effects of losing coverage are not just limited to the patient. Cuts have a ripple effect on patients’ children, their mothers and fathers, and seniors who depend on them for care. Because health care systems are reliant on Medicaid, cuts can even affect a community at large.”
The ACA originally mandated that Medicaid cover more people, but a Supreme Court ruling made the expansion voluntary. Today, 40 states and the District of Columbia have taken part. A body of research has shown that expansion to be a boon to public health, including a 2022 study led by Lee concluding that the expansion was associated with a reduction in deaths — an effect that was stronger in places where more previously uninsured people gained coverage.
The current Lancet article extrapolates from that study and a few others to show the flip side of the coin: What could happen if 15.5 million fewer Americans were covered by Medicaid?
Based on the reductions in mortality resulting from the expansion of Medicaid found in the 2022 study, the scientists determined that additional deaths among those aged 25 to 64 years old could reach 14,660 within a single year among – a number that ranks as the equivalent of the seventh leading cause of death in that age group across states which expanded coverage. Low-income rural populations could be disproportionately affected.
The researchers also examined catastrophic health care expenditures — a term defined by economists as out-of-pocket costs exceeding 30% of household income. The team estimated that more than 600,000 additional Americans between ages 25 and 64 could face this type of serious financial burden.
“We have to ask ourselves, how can anyone have the opportunity to succeed if they’re that deep in debt?” Lee said. “How can they be expected to contribute to society?”
Lack of insurance coverage can also pressure people to ignore some health problems rather than incur the costs required to address them. The research letter’s authors found that reversing the Medicaid expansion could lead up to 8.7 million people to avoid needed medical care. Putting off care for health issues when they are most easily treated can lead to worse outcomes and higher costs down the line.
“Time and time again, research has shown that preventative care and health coverage are actually cost saving,” Lee said. “The true, long-term effects of these decisions might be much larger than we expect and play out on a 10- to 20-year horizon.”
Reducing coverage could also touch the lives of people not currently enrolled in Medicaid. The investigators noted that funds from the program are so important to hospitals in underserved rural areas that cuts could result in closures, potentially leaving entire communities without reliable access to care.
The research letter’s first and corresponding author is Brooke Nichols of Boston University and Amsterdam University. Jennifer Dodge, a USC associate professor of research medicine and population and public health sciences, is a co-author, and Nahid Bhadelia and Jacob Bor, both of Boston University, are co-senior authors.
https://doi.org/10.1016/S0140-6736(25)00761-5