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Annual Review of Public Health

Volume 46, 2025

The Impact of Health Insurance on Mortality

  • Helen Levy1 and Thomas C. Buchmueller2
  • 1Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA; email: [email protected] 2Ross School of Business, University of Michigan, Ann Arbor, Michigan, USA
  • Vol. 46:541-550 (Volume publication date April 2025)
  • First published as a Review in Advance on January 10, 2025
  • Copyright © 2025 by the author(s).
    This work is licensed under a Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See credit lines of images or other third-party material in this article for license information.

Abstract

A 2008 review in the considered the question of whether health insurance improves health. The answer was a cautious yes because few studies provided convincing causal evidence. We revisit this question by focusing on a single outcome: mortality. Because of multiple high-quality studies published since 2008, which exploit new sources of quasi-experimental variation as well as new empirical approaches to evaluating older data, our answer is more definitive. Studies using different data sources and research designs provide credible evidence that health insurance coverage reduces mortality. The effects, which tend to be strongest for adults in middle age or older and for children, are generally evident shortly after coverage gains and grow over time. The evidence now unequivocally supports the conclusion that health insurance improves health.

Keyword(s): health insurance, Medicaid, Medicare, mortality, uninsured
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2025-04-04
2025-06-19
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Literature Cited

  1. 1.
    Abaluck J, Caceres Bravo M, Hull P, Starc A. 2021.. Mortality effects and choice across private health insurance plans. . Q. J. Econ. 136:(3):1557–610
     [Crossref] [Google Scholar]
  2. 2.
    Allen H, Sommers BD. 2019.. Medicaid expansion and health: assessing the evidence after 5 years. . JAMA 322:(13):1253–54
     [Crossref] [Google Scholar]
  3. 3.
    Angrist JD, Pischke J-S. 2010.. The credibility revolution in empirical economics: how better research design is taking the con out of econometrics. . J. Econ. Perspect. 24:(2):3–30
     [Crossref] [Google Scholar]
  4. 4.
    Antonisse L, Garfield R, Rudowitz R, Artiga S. 2018.. The effects of Medicaid expansion under the ACA: updated findings from a literature review. Issue Brief, KFF, San Franc:. https://files.kff.org/attachment/Issue-Brief-The-Effects-of-Medicaid-Expansion-Under-the-ACA-Updated-Findings
    [Google Scholar]
  5. 5.
    Ashenfelter OC. 2014.. The early history of program evaluation and the Department of Labor. . ILR Rev. 67:(3_Suppl.):574–77
     [Crossref] [Google Scholar]
  6. 6.
    Atherly A, Dowd BE, Coulam RF, Guy G. 2012.. The effect of HIFA waiver expansions on uninsurance rates in adult populations. . Health Serv. Res. 47:(3 Pt. 1):939–62
     [Crossref] [Google Scholar]
  7. 7.
    Black B, Hollingsworth A, Nunes L, Simon K. 2022.. Simulated power analyses for observational studies: an application to the Affordable Care Act Medicaid expansion. . J. Public Econ. 213::104713
     [Crossref] [Google Scholar]
  8. 8.
    Borgschulte M, Vogler J. 2020.. Did the ACA Medicaid expansion save lives?. J. Health Econ. 72::102333
     [Crossref] [Google Scholar]
  9. 9.
    Brot-Goldberg ZC, Chandra A, Handel BR, Kolstad JT. 2017.. What does a deductible do? The impact of cost-sharing on health care prices, quantities, and spending dynamics. . Q. J. Econ. 132:(3):1261–318
     [Crossref] [Google Scholar]
  10. 10.
    Brown DW, Kowalski AE, Lurie IZ. 2020.. Long-term impacts of childhood Medicaid expansions on outcomes in adulthood. . Rev. Econ. Stud. 87:(2):792–821
     [Crossref] [Google Scholar]
  11. 11.
    Card D. 2022.. Design-based research in empirical microeconomics. . Am. Econ. Rev. 112:(6):1773–81
     [Crossref] [Google Scholar]
  12. 12.
    Card D, Dobkin C, Maestas N. 2009.. Does Medicare save lives?. Q. J. Econ. 124:(2):597–636
     [Crossref] [Google Scholar]
  13. 13.
    Card D, Shore-Sheppard LD. 2004.. Using discontinuous eligibility rules to identify the effects of the federal Medicaid expansions on low-income children. . Rev. Econ. Stat. 86:(3):752–66
     [Crossref] [Google Scholar]
  14. 14.
    Currie J, Gruber J. 1996.. Health insurance eligibility, utilization of medical care, and child health. . Q. J. Econ. 111:(2):431–66
     [Crossref] [Google Scholar]
  15. 15.
    Currie J, Gruber J. 1996.. Saving babies: the efficacy and cost of recent changes in the Medicaid eligibility of pregnant women. . J. Political Econ. 104:(6):1263–96
     [Crossref] [Google Scholar]
  16. 16.
    Cutler DM, Gruber J. 1996.. Does public insurance crowd out private insurance?. Q. J. Econ. 111:(2):391–430
     [Google Scholar]
  17. 17.
    Dunn A, Shapiro AH. 2019.. Does Medicare Part D save lives?. Am. J. Health Econ. 5:(1):126–64
     [Google Scholar]
  18. 18.
    Finkelstein A, Taubman S, Wright B, Bernstein M, Gruber J, et al. 2012.. The Oregon health insurance experiment: evidence from the first year. . Q. J. Econ. 127:(3):1057–106
     [Google Scholar]
  19. 19.
    Goldin J, Lurie IZ, McCubbin J. 2021.. Health insurance and mortality: experimental evidence from taxpayer outreach. . Q. J. Econ. 136:(1):1–49
     [Google Scholar]
  20. 20.
    Goodman-Bacon A. 2018.. Public insurance and mortality: evidence from Medicaid implementation. . J. Political Econ. 126:(1):216–62
     [Google Scholar]
  21. 21.
    Goodman-Bacon A. 2021.. The long-run effects of childhood insurance coverage: Medicaid implementation, adult health, and labor market outcomes. . Am. Econ. Rev. 111:(8):2550–93
     [Google Scholar]
  22. 22.
    Gruber J, Sommers BD. 2019.. The Affordable Care Act's effects on patients, providers, and the economy: what we've learned so far. . J. Policy Anal. Manag. 38:(4):1028–52
     [Google Scholar]
  23. 23.
    Guth M, Ammula M. 2021.. Building on the evidence base: studies on the effects of Medicaid expansion, February 2020 to March 2021. Rep. , KFF, San Franc:. https://www.kff.org/medicaid/report/building-on-the-evidence-base-studies-on-the-effects-of-medicaid-expansion-february-2020-to-march-2021/
    [Google Scholar]
  24. 24.
    Guth M, Garfield R, Rudowitz R. 2020.. The effects of Medicaid expansion under the ACA: studies from January 2014 to January 2020. Rep., KFF, San Franc:. https://www.kff.org/medicaid/report/the-effects-of-medicaid-expansion-under-the-aca-updated-findings-from-a-literature-review/
    [Google Scholar]
  25. 25.
    Huh J, Reif J. 2017.. Did Medicare part D reduce mortality?. J. Health Econ. 53::17–37
     [Google Scholar]
  26. 26.
    Inst. Med. Comm. Conseq. Uninsur. 2002.. Care Without Coverage: Too Little, Too Late. Washington, DC:: Natl. Acad. Press
     [Google Scholar]
  27. 27.
    KFF. 2010.. Expanding Medicaid to low-income childless adults under health reform: key lessons from state experiences. Issue Brief, KFF, San Franc:. https://www.kff.org/affordable-care-act/issue-brief/expanding-medicaid-to-low-income-childless-adults/
    [Google Scholar]
  28. 28.
    Levy H, Meltzer D. 2008.. The impact of health insurance on health. . Annu. Rev. Public Health 29::399–409
     [Google Scholar]
  29. 29.
    Mazurenko O, Balio CP, Agarwal R, Carroll AE, Menachemi N. 2018.. The effects of Medicaid expansion under the ACA: a systematic review. . Health Aff. 37:(6):944–50
     [Google Scholar]
  30. 30.
    McWilliams JM. 2009.. Health consequences of uninsurance among adults in the United States: recent evidence and implications. . Milbank Q. 87:(2):443–94
     [Google Scholar]
  31. 31.
    Miller S, Johnson N, Wherry LR. 2021.. Medicaid and mortality: new evidence from linked survey and administrative data. . Q. J. Econ. 136:(3):1783–829
     [Google Scholar]
  32. 32.
    Polsky D, Doshi JA, Escarce J, Manning W, Paddock SM, et al. 2009.. The health effects of Medicare for the near-elderly uninsured. . Health Serv. Res. 44:(3):926–45
     [Google Scholar]
  33. 33.
    Polsky D, Doshi JA, Manning WG, Paddock S, Cen L, et al. 2010.. Response to McWilliams commentary: “Assessing the Health Effects of Medicare Coverage for Previously Uninsured Adults: A Matter of Life and Death?. ” Health Serv. Res. 45:(5 Part 1):1423–29
     [Google Scholar]
  34. 34.
    Powell D. 2018.. Imperfect synthetic controls: Did the Massachusetts health care reform save lives? Work. Pap. WR-1246 , RAND, Santa Monica, CA:. https://www.rand.org/content/dam/rand/pubs/working_papers/WR1200/WR1246/RAND_WR1246.pdf
    [Google Scholar]
  35. 35.
    Sohn H. 2017.. Medicaid's lasting impressions: population health and insurance at birth. . Soc. Sci. Med. 177::205–12
     [Google Scholar]
  36. 36.
    Sommers BD, Long SK, Baicker K. 2014.. Changes in mortality after Massachusetts health care reform: a quasi-experimental study. . Ann. Intern. Med. 160:(9):585–93
     [Google Scholar]
  37. 37.
    Soni A, Wherry LR, Simon KI. 2020.. How have ACA insurance expansions affected health outcomes? Findings from the literature. . Health Aff. 39:(3):371–78
     [Google Scholar]
  38. 38.
    Wherry LR, Meyer BD. 2016.. Saving teens: using a policy discontinuity to estimate the effects of Medicaid eligibility. . J. Hum. Resour. 51:(3):556–88
     [Google Scholar]
  39. 39.
    Woolhandler S, Himmelstein DU. 2017.. The relationship of health insurance and mortality: Is lack of insurance deadly?. Ann. Intern. Med. 167:(6):424–31
     [Google Scholar]
  40. 40.
    Wyse A, Meyer B. 2023.. Saved by Medicaid: new evidence on health insurance and mortality from the universe of low-income adults. Job Mark. Pap., Univ. Chicago, Harris Sch. Public Policy, Chicago:. https://www.angelawyse.com/research
    [Google Scholar]
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The Impact of Health Insurance on Mortality
Annual Review of Public Health 46, 541 (2025); https://doi.org/10.1146/annurev-publhealth-061022-042335
/content/journals/10.1146/annurev-publhealth-061022-042335
/content/journals/10.1146/annurev-publhealth-061022-042335
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