P3.P315: The Impact of Medicaid Expansion on Life Expectancy in the U.S

Background: In 2013, nearly 15% of all Americans lacked health insurance according to the U.S Census, resulting in significant disparities in access to affordable healthcare. The expansion of Medicaid via the Patient Protection and Affordable Care Act has lessened this financial burden for millions of patients, particularly those from low-income, rural communities. This has also had a profound effect on children’s health as Medicaid now insures nearly 40% of all US children and 80% of children living under the federal poverty line. Greater accessibility of Medicaid may lead to overall positive health outcomes by facilitating access to care. As such, this study aims to quantify the impact of Medicaid expansion on life expectancy in the U.S. via a county-based analysis.

Methods: Bordering counties of states that did and did not adopt Medicaid expansion between 2009 and 2018 were collected. The change in life expectancy by county from 2009 to 2018 was determined using data from the Institute for Health Metrics and Evaluation. Poverty rates, percentage of non-White citizens, and median age by county were collected from U.S. Census data. Summary statistics were then calculated. An unadjusted linear regression was used to determine the association between the status of Medicaid expansion and change in life expectancy by county. This was repeated using an adjusted linear regression, controlling for the poverty rate, median age, and percentage of non-White citizens by county. The beta value (slope), p-value, and 95% confidence interval for each variable were calculated.

Results: Medicaid expansion was found to be positively associated with the change in life expectancy in the U.S. after controlling for poverty rate, median age, and percentage of non-White citizens by county. Adjusted analyses revealed that for each year that Medicaid was implemented, there was an associated statistically significant 0.32 unit increase in the life expectancy per given county (p=.01). Further subgroup analysis by region demonstrated this association was most strongly seen in the Midwest (𝛽=.43, p < .008).

Conclusion: Results indicate that the implementation of Medicaid expansion throughout the U.S was associated with an increase in average life expectancy, especially in the Midwest. Prior to the initial 2014 expansion of Medicaid, rural America housed a significantly greater percentage of uninsured patients and children compared to their urban counterparts. With the expansion of Medicaid, the associated increase in life expectancy can potentially be attributed to minimizing some of the health disparities that predominate in rural communities, chief among them access to healthcare. These findings underscore the importance of maintaining and expanding health insurance coverage for both adult and pediatric populations.