Medicaid rollbacks could account for more than 14,000 additional deaths, study warns

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As Congress advances proposals to unwind the Affordable Care Act’s (ACA’s) Medicaid expansion, a new study in The Lancet warns that doing so could have dire public health consequences — including nearly 15,000 additional deaths per year among working-age adults.

The peer-reviewed analysis, by researchers from the Keck School of Medicine at USC, Boston University and Amsterdam University, estimates that eliminating Medicaid coverage for 15.5 million people across 40 states and D.C. would result in as many as 14,660 excess deaths in a single year — a mortality toll that would rank as the seventh leading cause of death among Americans ages 25 to 64.

“More than 70 million people depend on Medicaid for everything that has to do with their health, whether it’s for preventive care, accidents or surgeries,” said Brian P. Lee, MD, co-senior author and an associate professor of clinical medicine at USC. “The devastating effects of losing coverage are not just limited to the patient. Cuts have a ripple effect on patients’ children, their mothers and fathers, and seniors who depend on them for care. Because health care systems are reliant on Medicaid, cuts can even affect a community at large.”

The findings come amid a broader push from House Republicans and the Trump administration's Department of Government Efficiency (DOGE) to reduce federal health spending. The proposals target the enhanced funding match for states that expanded Medicaid under the ACA, a provision the U.S. Supreme Court later made optional. To date, 40 states and Washington, D.C., have adopted the expansion, extending coverage to millions of low-income adults.

The study’s authors extrapolated their projections from prior research, including a 2022 Lancet Public Health study linking Medicaid expansion to an 11.8-per-100,000 drop in mortality among adults 25-64. Reversing that coverage, they wrote, would likely have a “swift and measurable impact on death rates, particularly in low-income and rural populations.”

But the consequences go beyond mortality.

Researchers estimate that more than 623,000 adults would face catastrophic health costs — defined as out-of-pocket medical bills exceeding 30% of household income — if coverage is withdrawn.

“We have to ask ourselves, how can anyone have the opportunity to succeed if they’re that deep in debt?” Lee said. “How can they be expected to contribute to society?”

An estimated 8.7 million people would likely forgo necessary care due to cost if the cuts are enacted, the study added, setting the stage for worsening chronic conditions, delayed diagnoses and higher long-term expenditures.

“Time and time again, research has shown that preventative care and health coverage are actually cost saving,” Lee said. “The true, long-term effects of these decisions might be much larger than we expect and play out on a 10- to 20-year horizon.”

Researchers also cautioned that rural hospitals — many of which rely heavily on Medicaid reimbursement — could face closures, leaving entire communities without access to care, regardless of their insurance status.

“Policy makers should carefully weigh the health and financial consequences of these cuts for their constituents,” the authors wrote.