For six decades, Medicare has functioned as a cornerstone of the American social safety net, designed to provide affordable healthcare to citizens once they reach the age of 65. This system is funded primarily through payroll taxes, with workers contributing steadily over their lifetimes, trusting that they will gain access to coverage in their senior years. However, the promise Medicare holds is increasingly unattainable for a growing segment of the population, especially Black Americans. A pioneering study from Brown University and Harvard University reveals a disturbing rise in premature deaths—those occurring before eligibility for Medicare—that undermines the very foundation of the program.
The comprehensive analysis, drawing upon mortality data spanning all 50 states from 2012 through 2022, documents a striking 27% increase in deaths among adults aged 18 to 64. Even more alarming is the disproportionate impact on Black adults, who experienced a 38% rise in premature mortality, markedly outpacing the 28% increase recorded among white Americans. This divergence spotlights persisting racial inequities deeply embedded within public health dynamics, which in turn threaten the equitable distribution of Medicare benefits.
Lead author Irene Papanicolas of the Brown University School of Public Health contextualizes the findings poignantly: those who have contributed financially to Medicare throughout their working lives are denied the opportunity to reap its benefits due to premature mortality. This disparity, as she notes, is stark along racial lines. “When viewed through the lens of race, it becomes clear that an increasing number of Black Americans never reach the age of 65 to receive the coverage they helped fund,” Papanicolas emphasizes.
Medicare, since its inception in 1965, has primarily served individuals aged 65 and older, offering health coverage that is crucial in managing chronic conditions and age-related diseases. Currently, approximately 69 million Americans are enrolled, with the vast majority being seniors. Yet, as the study reveals, a rising tide of early mortality undermines the program’s universality. Shorter life spans mean that a significant number of contributors die before qualifying for Medicare coverage, disrupting the risk pool balance fundamental to program sustainability.
The research team methodically parsed Medicare enrollment files alongside death records from the Centers for Disease Control and Prevention (CDC). Their focus was on adults between 18 and 64 who died within the studied decade, with adjustments made to exclude those who were Medicare-eligible due to disability or other non-age-related reasons. This refined approach illuminated the trend of premature deaths most relevant to understanding Medicare’s coverage gap due to early mortality.
One limitation the study encountered was the inconsistent recording of race and ethnicity in federal databases, which restricted the detailed analysis to Black and white populations only. Despite this, the data underscored persistent and widening racial disparities: Black adults faced substantially higher rates of premature death consistently across all states. In 2012, the mortality rate among Black adults aged 18-64 stood at 309 deaths per 100,000 individuals, compared to 247 per 100,000 among white adults. By 2022, the rates surged to 427 and 316 per 100,000 respectively, illustrating a grim escalation.
Geographically, the study also revealed considerable state-by-state variation in premature mortality rates. West Virginia emerged as the state grappling with the highest early death rate in 2022, while Massachusetts recorded the lowest. Most states exhibited a racial disparity favoring white adults, with only New Mexico, Rhode Island, and Utah showing no significant difference in early mortality between Black and white populations. These geographic trends point to underlying socio-economic and healthcare access factors influencing mortality.
Jose Figueroa, a co-author affiliated with Harvard University’s Department of Health Policy, stresses the structural inequities embedded in the Medicare framework. “The disproportionate burden of premature death borne by Black Americans effectively enshrines systemic inequities within a program originally designed to be universal,” Figueroa argues. The persistence and expansion of these disparities across nearly every state underscore a critical failure in public health policy.
This research arrives amid a troubling era for U.S. life expectancy, which has been declining for much of the past decade, bucking global trends. Notably, even higher-income Americans—historically shielded from many health risks—have seen deteriorations in longevity. The study also points to a rise in preventable deaths, particularly during midlife, broadly classified as ages 40 to 65. This middle age group is experiencing increased health complications that may not align well with Medicare’s eligibility benchmarks.
The findings challenge fundamental questions about the timing of health care access in the U.S. system. If Americans are increasingly succumbing to health burdens before reaching the Medicare age threshold, then the program’s alignment with population health needs is at odds with reality. Papanicolas underscores that rising midlife health demands raise urgent policy concerns: “Does it still make sense to structure healthcare access solely by age when so many are ill or dying before they turn 65?”
Importantly, while the U.S. population is aging, with numbers of seniors projected to grow, the increase in premature mortality reveals a misalignment between when populations need care most and when coverage becomes accessible. This gap exacerbates socioeconomic and racial disparities, further entrenching inequities in health outcomes and financial protections.
An ironic and troubling aspect highlighted by the study is that money contributed by those who die prematurely remains locked within Medicare, benefiting others but never the contributors themselves. Papanicolas advocates for a policy shift that ties healthcare access to actual health needs rather than rigid age cutoffs, aiming to create a more equitable and responsive system.
This groundbreaking research, supported by the National Institute on Aging, paints a sobering picture of the evolving challenges facing Medicare in the 21st century. It calls for urgent reconsideration of how health coverage is structured amid shifting demographic and public health realities, spotlighting the intersection of race, mortality, and healthcare policy in America.
Subject of Research: People
Article Title: Racial Disparities in Premature Mortality and Unrealized Medicare Benefits Across US States
News Publication Date: 7-Nov-2025
Web References: https://jamanetwork.com/journals/jama-health-forum/fullarticle/10.1001/jamahealthforum.2025.4916?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=110725
References: JAMA Health Forum, DOI: 10.1001/jamahealthforum.2025.4916
Keywords: Health care, Morbidity, Public health
