A recent working paper from the University of Chicago presents compelling evidence that expanding access to health insurance can save lives. The study focuses on Medicaid expansions under the 2010 Affordable Care and Patient Protection Act, also known as "Obamacare," and earlier state waivers. It found a 2.5% reduction in mortality among low-income adults, translating to a 21% decrease in the mortality hazard for new enrollees, saving approximately 27,400 lives from 2010 to 2022.
The research indicates that an additional 12,800 deaths could have been prevented if all states had chosen to expand Medicaid. This study is coauthored by Bruce D. Meyer, McCormick Foundation Professor at the UChicago Harris School of Public Policy, and Angela Wyse, PhD’24, an assistant professor of economics at Dartmouth College. They analyzed a dataset of 37 million low-income adults by linking 2010 Census records with administrative tax data.
Their findings reveal that Medicaid expansions led to a 12% increase in enrollment and significantly reduced mortality across different age groups. Notably, younger adults accounted for nearly half of the life-years saved. Meyer highlighted the importance of these findings: “With younger adults comprising a large share of the low-income population and having more years ahead, their survival gains have especially high policy relevance, and have not been studied in this way before.” He added that policymakers should consider these impacts when making changes to Medicaid in upcoming budget discussions.
The study also evaluates cost-effectiveness. It concludes that each life saved through expansion cost about $5.4 million or $179,000 per life-year saved—figures well below standard benchmarks used to assess economic value in health interventions.
Wyse emphasized the implications for policymakers: “For policymakers grappling with questions about the costs and benefits of expanding public health insurance,” she noted, “the findings of our work suggest that not only did the ACA have significant impacts on health outcomes—saving tens of thousands of lives—it did so in what appears to be a relatively cost-effective way.”