Life of the uninsured

Premature death

The uninsured not only suffer from health declines — they also die earlier. Studies following older middle-aged (ages 51–64) adults into old age demonstrated that individuals who were uninsured died at younger ages when compared with those of the same age and original health status who were privately insured.

States that expanded Medicaid decreased lack of insurance by 15 percent. In five years, they saw a 6 percent decline in deaths of adults ages 20–64.

The one-third greater mortality of older adults who lacked health insurance was roughly equivalent to the risk of smoking. The lack of health insurance in older middle age could rank as the third leading cause of death, behind heart disease and cancer. A 2009 study based on a representative sample of the U.S. population and adjusted for detailed health information estimated that between 35,000 and 45,000 Americans ages 18–64 die annually due to lack of health insurance. It is difficult to detect the health effects of being uninsured, because at any point most of the uninsured are healthy. When major health declines or illnesses do occur, previously uninsured individuals then qualify for disability and Medicaid. Being uninsured is often a temporary condition, with individuals cycling in and out of employment-based insurance as they change or lose jobs. And the uninsured do receive health care at public hospitals, clinics and hospital emergency rooms. It has thus remained difficult to demonstrate convincingly that providing health insurance to the uninsured will have a major effect.

Medicaid lottery study