• Posted April 4, 2025

Medicaid Expansion Protected Americans During COVID-19 Pandemic

Americans received some protection against death during the COVID-19 pandemic if they lived in a state that had expanded its Medicaid program under the Affordable Care Act (ACA), a new study says.

Even though death rates rose nationwide during the pandemic, Medicaid expansion states experienced a slower increase in deaths compared to states that didn’t take advantage of the ACA’s provision, researchers reported April 3 in the American Journal of Public Health.

The results suggest that Medicaid expansion offered a protective effect on people’s health in the U.S. during the pandemic, researchers said.

“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,” lead researcher Xuesong Han, scientific director of health services research at the American Cancer Society, said in a news release.

“Medicaid expansion under the Affordable Care Act could improve access to care and reduce health disparities during the public health emergency,” Han added.

For the study, researchers analyzed death records from 2018 to 2022 among people 20 to 64 across the United States.

On average, the death rate increased by 100 deaths per 100,000 person-years in Medicaid expansion states from 2018 to 2022, but by nearly 133 deaths per 100,000 person-years in states that didn’t expand Medicaid, results show.

Person-years refers to the amount of time that people in a study are followed until they either die or the study ends. 

The upshot: Medicare expansion led to longer lives against the upheaval of the pandemic.

“With 10 states having yet to expand Medicaid eligibility, our findings add to the growing body of evidence for the benefits of Medicaid expansion,” Han added. “Additionally, findings highlight the importance of maintaining support for existing Medicaid coverage in 40 states and the District of Columbia.”

Lisa Lacasse, president of ACS’s advocacy affiliate, the American Cancer Society Cancer Action Network, said the study reinforces well-established evidence that Medicaid expansion improves health outcomes and reduces health disparities. 

“Ensuring individuals have access to quality, affordable health insurance through Medicaid is critical to the fiscal and physical health of our country,” Lacasse said in a news release. “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.”

More information

KFF has more on state Medicaid expansion.

SOURCE: American Cancer Society, news release, April 3, 2025