For over six decades, Medicare has functioned as a vital social insurance program in the United States, providing affordable health coverage primarily to individuals aged 65 and older. This system operates on a fundamental expectation: that working Americans contribute to the scheme through payroll taxes throughout their lives, thereby securing health care access in their later years. However, a recent comprehensive study conducted by researchers at Brown University in collaboration with Harvard University reveals a disquieting trend. An increasing number of Americans, especially within Black communities, are experiencing premature deaths before reaching Medicare eligibility age, effectively losing access to the benefits they have subsidized through lifelong contributions.
The study, published in the esteemed journal JAMA Health Forum, draws upon a robust analysis of national mortality and Medicare enrollment data spanning from 2012 to 2022. Through this decade-long examination of federal mortality statistics across all 50 states, researchers determined that premature death rates for adults aged 18 to 64 escalated by a staggering 27%. Of particular concern is the disproportionate impact on Black Americans, who have witnessed a 38% surge in premature mortality, compared with a 28% increase observed among white Americans. These disparities starkly illuminate the ongoing structural inequities embedded within the U.S. health system and call into question the universality of Medicare’s promise.
At the core of Medicare’s design is the premise of universality and fairness, funded predominantly through payroll taxes levied on workers. However, premature mortality undermines this ideal by excluding a growing segment of contributors from ever realizing Medicare benefits. Irene Papanicolas, a professor specializing in health services, policy, and practice at Brown University, emphasizes that these losses are not trivial. “These are individuals who have contributed financially to the program their entire lives yet do not survive to access its coverage,” Papanicolas states. This incongruity not only reflects a growing health crisis but also perpetuates systemic racial inequities, as Black Americans disproportionately bear the brunt of this premature mortality.
Methodologically, the research team meticulously parsed Medicare enrollment data alongside mortality records procured from the Centers for Disease Control and Prevention (CDC). By isolating deaths among adults aged 18 to 64 while excluding those already eligible for Medicare due to disability or other qualifying conditions, the researchers could more accurately identify individuals who paid into Medicare yet died prematurely. A significant limitation was the inconsistent recording of race and ethnicity across datasets, constraining detailed analyses primarily to comparisons between Black and white populations, but even within these parameters, the findings reveal stark racial disparities.
The quantified results underscore a nation confronting a premature mortality crisis. Premature deaths nationwide rose from 243 per 100,000 adults in 2012 to 309 per 100,000 in 2022. For Black adults, the rate climbed from 309 to 427, a disturbing indication of widening inequality, as rates for white adults increased from 247 to 316 per 100,000 within the same period. Geographic variability further complicates this picture. West Virginia registered the highest premature mortality rates in 2022, reflecting perhaps the lingering effects of economic and health system challenges there, while states such as Massachusetts reported the lowest. Notably, nearly every state exhibited higher premature death rates for Black Americans, with statistically insignificant differences found only in New Mexico, Rhode Island, and Utah.
Co-author Jose Figueroa of Harvard University accentuates how these trends effectively embed structural inequity into Medicare’s architecture. “Because premature mortality disproportionately affects Black Americans, the current design of the Medicare program effectively bakes structural inequity into a system that was meant to be universal,” Figueroa explains. The persistence and worsening of these discrepancies across almost all states indicate that current health policies and interventions have not adequately addressed underlying socioeconomic and health determinants driving premature deaths.
The broader public health implications of these findings intersect with long-term demographic trends. While the U.S. population continues to age, with the cohort over 65 years steadily expanding, these figures reveal a troubling mismatch. Increasing premature death rates mean that many individuals lose access to healthcare benefits precisely when health problems accelerate in midlife, usually defined as ages 40 to 65. Researchers note that rising preventable deaths contribute significantly to this trend, with chronic diseases, substance use, and other social determinants exacerbating mortality risks midlife. This divergence calls into question whether Medicare’s age-based eligibility remains aligned with the actual distribution of health risks and care needs in today’s population.
Increased health demands during midlife raise pressing questions about the adequacy and equity of healthcare coverage. Irene Papanicolas reflects on this shifting landscape, highlighting, “What we’re increasingly seeing is that Americans have increased health needs during midlife, which raises the question for policymakers: Does the system still work if more people are getting sick and dying before the age of 65?” This systemic misalignment suggests urgent need for reforms that might expand coverage eligibility or integrate age-independent criteria better attuned to contemporary health realities.
The study’s authors also acknowledge limitations in current data infrastructure that obscure the full scope of disparities. The inability to robustly analyze other racial and ethnic groups points to challenges in how demographic information is codified across federal data systems. Meanwhile, the researchers contend that despite these constraints, the documented disparities offer compelling evidence that urgent policy attention must be directed towards addressing the root causes of premature mortality, including socioeconomic inequities, barriers to healthcare access, and structural determinants of health.
From a fiscal perspective, the study underscores a paradox within the Medicare trust fund. While individuals who die prematurely do not consume Medicare benefits, the funds they contribute through payroll taxes remain within the system, partially masking these inequities financially. Nevertheless, this dynamic does not mitigate the profound social injustice inherent in the system’s current configuration, where those most burdened by premature mortality lose the opportunity to reap the benefit of their contributions. The authors argue persuasively that public health policy should aim to realign benefits with actual health needs rather than rigid age cutoffs.
The findings of this research add to a growing body of evidence illustrating the deteriorating trends in U.S. life expectancy, which has been falling for much of the past decade across virtually all socioeconomic strata. Even historically more privileged groups with greater wealth and access to healthcare experience declining longevity, signaling systemic failures. The increase in burden from preventable deaths, especially in midlife, highlights critical gaps in prevention, health equity, and social support systems which exacerbate premature mortality trends and compound inequities.
In conclusion, the study published in JAMA Health Forum charts a critical public health and policy challenge facing the United States: the rising tide of premature mortality undermines both the foundational fairness and practical efficacy of Medicare as a social insurance program. The racial disparities exposed in this decade-long analysis call out systemic inequities that are not only persisting but deepening across states. To uphold Medicare’s promise, innovative strategies that expand coverage, address social determinants of health, and recalibrate eligibility criteria in line with current demographic and epidemiological realities are imperative.
Subject of Research:
Racial disparities in premature mortality and the resulting inequities in access to Medicare benefits among U.S. adults aged 18 to 64.
Article Title:
Racial Disparities in Premature Mortality and Unrealized Medicare Benefits Across US States
News Publication Date:
Not explicitly stated; the referenced study covers data through 2022 and was published in 2025.
Web References:
• https://jamanetwork.com/journals/jama-health-forum/fullarticle/10.1001/jamahealthforum.2025.4916
• https://brown.edu/news/2025-04-02/wealth-mortality-gap
• https://brown.edu/news/2025-03-24/avoidable-deaths
• https://www.nytimes.com/2023/06/22/us/census-median-age.html
• https://www.prb.org/resources/fact-sheet-aging-in-the-united-states/
References:
Papanicolas, I., Figueroa, J., et al. “Racial Disparities in Premature Mortality and Unrealized Medicare Benefits Across US States.” JAMA Health Forum, 2025. DOI: 10.1001/jamahealthforum.2025.4916
Keywords:
Health disparity, Health equity, Health care costs, Public health
