ACA Reduced Mortality Beyond Medicaid

An NBER working paper using NHIS Linked Mortality Files and difference‑in‑differences (and triple‑difference) designs finds that the Affordable Care Act lowered mortality in 40–58‑year‑olds even after separating out the effects of state Medicaid expansions. Surprisingly, the authors report no detectable mortality benefit from Medicaid expansion itself while the broader ACA (insurance reforms beyond Medicaid) produced the mortality decline. — This changes the policy framing: gains in life expectancy may come from the ACA’s non‑Medicaid mechanisms (insurance market reforms, coverage gains in non‑expansion states), which matters for debates over which reforms to prioritize and fund.