A groundbreaking new analysis has raised urgent alarms about the potentially devastating consequences of scaling back Medicaid access in the United States. Emerging from a collaboration among researchers at the Keck School of Medicine of USC, Boston University, and the University of Amsterdam, this study rigorously quantifies the public health and economic fallout that could result from reductions to Medicaid coverage, a cornerstone of American health insurance policy enacted through the Affordable Care Act (ACA). The findings deliver sobering evidence that millions of working-age Americans could face dire outcomes, including thousands of premature deaths and severe financial distress triggered by increased out-of-pocket health expenditures.
Medicaid’s role in the American healthcare system is both complex and critical. As a joint federal-state initiative, it provides health insurance to individuals who cannot secure coverage through employer-sponsored plans, private insurers, or Medicare, which primarily serves seniors and the disabled. Despite common misconceptions, Medicaid covers a broad spectrum of the population, including a large number of working adults. It’s noteworthy that approximately 40% of all births in the United States rely on Medicaid funding. States administer the program under various names, such as Medi-Cal in California or MassHealth in Massachusetts, but the program’s scope and influence remain uniform nationwide. Its extensive coverage includes preventive care, acute medical interventions, and support for chronic conditions.
The cornerstone research letter published in The Lancet applies sophisticated data and statistical analysis methods to extrapolate the effects of Medicaid policy changes from prior empirical studies. Building on a landmark 2022 study led by Dr. Brian P. Lee, associate professor at USC’s Keck School of Medicine, the researchers project the dramatic consequences that could unfold if Medicaid coverage were reduced by 15.5 million individuals. Their model estimates that such a contraction in access to Medicaid could precipitate approximately 14,660 additional deaths within a single year in the 25 to 64-year-old demographic. This figure places Medicaid coverage cuts as the seventh leading cause of mortality among working-age adults, underscoring the program’s vital role in sustaining life.
The predicted mortality increase is not evenly distributed; rather, it disproportionately impacts vulnerable populations. Low-income rural communities stand at the epicenter of this impending crisis. These areas already grapple with limited healthcare infrastructure and higher baseline morbidity and mortality. A reduction in Medicaid funding threatens to exacerbate existing health disparities by diminishing individuals’ capacity to obtain timely medical attention. Reduced Medicaid access amplifies barriers to health services where provider availability is already tenuous, risking widening the health outcome chasm between urban centers and underserved regions.
Beyond mortality risks, the analysis highlights the profound economic repercussions Medicaid cuts could inflict. The authors introduce the concept of catastrophic health expenditure, defined as out-of-pocket healthcare spending surpassing 30% of household income. The study anticipates that over 600,000 working-age Americans could be thrust into this category, bearing serious financial burdens from medical bills that threaten economic stability and even lead to personal bankruptcy. Financial precarity engendered by health-related costs disrupts household economics and erodes socioeconomic progress, bringing to the forefront questions about social mobility and community resilience.
This grim prospect extends its harmful reach even further. Without adequate insurance coverage, many individuals may opt to delay or forgo medical care to avoid prohibitive costs, a decision fraught with consequences. The researchers estimate that as many as 8.7 million people might avoid necessary medical attention following Medicaid rollbacks. Postponing preventive services or early interventions can lead to exacerbated disease states, increased incidence of acute medical crises, and ultimately, higher aggregate healthcare expenditures. This deferred care pathway undermines not only individual health outcomes but also strains emergency care systems and weakens public health preparedness.
Dr. Brian P. Lee emphasizes the multifaceted ripple effects of Medicaid cuts. The ramifications extend beyond direct beneficiaries to affect families and entire communities. Loss of coverage disrupts family caregiving dynamics, impacts dependents including children, and places additional stress on seniors relying on younger relatives for support. Health systems themselves are deeply intertwined with Medicaid funding; its contraction risks destabilizing critical facilities, especially hospitals serving underserved and rural populations. Such financial distress could lead to healthcare facility closures, leaving entire regions bereft of reliable, accessible care and thereby diminishing healthcare infrastructure resilience.
The Affordable Care Act’s Medicaid expansion was originally designed to extend vital coverage to millions, but the Supreme Court’s decision to make expansion optional has led to variability in uptake—currently, 40 states plus the District of Columbia participate. There is now a substantial and compelling body of research demonstrating the public health benefits of this expansion, including lower mortality rates and improved healthcare utilization metrics among newly insured populations. This research letter flips this narrative to illustrate the catastrophic outcomes that reversing expansion could trigger, effectively serving as a stark warning against policy reversals.
From a health economics perspective, the analysis sheds light on the nuanced and long-term fiscal impacts of Medicaid policy shifts. Preventive care and early disease management covered under Medicaid are not only life-saving but also cost-saving over the long horizon. The avoidance of costly emergency care and hospitalizations translates into substantial savings for both healthcare systems and society. The study emphasizes that these benefits accrue over decades, which policymakers often overlook when discussing the budgetary implications of Medicaid funding.
The intricate balance Medicaid maintains between public health and economic stability is at risk. As researchers point out, Medicaid is more than a safety net; it is a fundamental pillar supporting the health of millions and the financial infrastructure of healthcare providers. Losing this support spells a cascade of negative consequences rippling throughout society. Hospitals in financially fragile rural areas stand particularly vulnerable to funding cuts, potentially triggering closures that leave medically underserved areas without necessary healthcare access—a public health challenge that reverberates nationwide.
The team behind this pivotal study includes Brooke Nichols, the first and corresponding author affiliated with Boston University and the University of Amsterdam. Along with co-authors Jennifer Dodge from USC and co-senior authors Nahid Bhadelia and Jacob Bor from Boston University, they collectively reinforce the scientific rigor and public policy relevance of these findings. The peer-reviewed publication appearing in The Lancet on April 30, 2025, reinforces the credibility and urgency behind the data presented.
As American policymakers contemplate Medicaid’s future, this study provides vital, quantifiable evidence about the stakes involved. The potential consequences of reducing Medicaid access extend far beyond individual health, threatening community welfare, economic stability, and healthcare accessibility nationwide. This research implores a deeper understanding of Medicaid’s irreplaceable role and cautions against policy decisions that could reverse hard-won gains in mortality reduction and financial protection for millions of working-age Americans. The intersection of healthcare provision and public policy, illuminated by this research, underscores Medicaid not only as an insurance program but as a crucial determinant of societal health and economic vitality.
Subject of Research: People
Article Title: Medicaid cuts, mortality, and health-care expenditure in the USA
News Publication Date: 30-Apr-2025
Web References:
- The Lancet article
- Keck School of Medicine of USC
References: 10.1016/S0140-6736(25)00761-5
Keywords: Health insurance; Health and medicine; Medical economics; Health care; Health care costs; Health care delivery; Health care policy; Public health; Public policy
