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ATLANTA, April 3, 2025 — Despite a nationwide rise in mortality rates during the COVID-19 pandemic, adults in Medicaid expansion states experienced a slower increase in deaths than non-expansion states, according to a new study led by American Cancer Society (ACS) researchers. These findings suggest a protective effect of Medicaid expansion on population health in the United States during the public health emergency. The findings are out today in the American Journal of Public Health (AJPH).
“This research is important because many people experienced employment disruptions during the pandemic, which, in addition to loss of household income, also led to loss of employment-based health insurance coverage,” said Dr. Xuesong Han, scientific director, health services research at the American Cancer Society and lead author of the study. “Medicaid expansion under the Affordable Care Act could improve access to care and reduce health disparities during the public health emergency.”
For the study, researchers analyzed 2018-2022 mortality surveillance data identifying deaths at ages 20-64 years old in 3,142 counties in the U.S. Age-adjusted mortality rates were calculated for each county and by cause of death. Changes in mortality rates pre- and post-COVID-19 pandemic (2018-19 versus 2021-22) in Medicaid expansion states relative to non-expansion states were calculated by adjusting for county sociodemographic factors and state-specific COVID-19 vaccination rates.
Study results showed the all-cause mortality rate increased in the U.S. nationwide in 2020-21, the first two years of the COVID-19 pandemic, and decreased slightly in 2022. Overall, the increase was slower in Medicaid expansion states, leading to a relative decrease of 31.8 per 100,000 person-years associated with Medicaid expansion from 2018-2019 to 2021-2022.
“With 10 states having yet to expand Medicaid eligibility, our findings add to the growing body of evidence for the benefits of Medicaid expansion,” Dr. Han added. “Additionally, findings highlight the importance of maintaining support for existing Medicaid coverage in 40 states and the District of Columbia. These data also highlight the importance of monitoring lasting effects of the COVID-19 pandemic on access to care and population health, especially as millions of people have lost coverage during post-pandemic Medicaid unwinding throughout 2023-2024.”
“This study reinforces the well-established evidence that Medicaid expansion improves health outcomes and reduces health disparities,” said Lisa A. Lacasse, president of ACS’s advocacy affiliate, the American Cancer Society Cancer Action Network (ACS CAN). “Ensuring individuals have access to quality, affordable health insurance through Medicaid is critical to the fiscal and physical health of our country. With Medicaid on the federal chopping block, it’s imperative that Congress recognize the indisputable value of this health insurance program and protect it from any form of cuts.”
Other ACS researchers contributing to this study include Kewei Sylvia Shi, Dr. Qinjin Fan, Dr. Parichoy Pal Choudhury, Dr. Xin Hu, and senior author Dr. Robin Yabroff.
Additional ACS Resources:
- Insurance and Cancer
- Insurance Coverage for Cancer Screening
- Medicaid Expansion Improves Post-Surgery Survival Among Adults With Non-Small Cell Lung Cancer
- New Research Shows Medicaid Expansion Improves Access to Care and Outcomes for Patients with Non-Small Cell Lung Cancer
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About the American Cancer Society
The American Cancer Society is a leading cancer-fighting organization with a vision to end cancer as we know it, for everyone. For more than 110 years, we have been improving the lives of people with cancer and their families as the only organization combating cancer through advocacy, research, and patient support. We are committed to ensuring everyone has an opportunity to prevent, detect, treat, and survive cancer. To learn more, visit cancer.org or call our 24/7 helpline at 1-800-227-2345. Connect with us on Facebook, X, and Instagram.