Medicare has been a safety net for Americans aged 65 and older since its creation in 1965. The program is primarily funded through payroll taxes and today covers nearly all Americans 65 and older, with about 69 million enrollees.
A study led by researchers at Brown University and Harvard University examined Medicare enrollment files and death records from the US Centers for Disease Control and Prevention across all 50 states. The team counted deaths among adults aged 18 to 64 from 2012 to 2022, excluding people already eligible for Medicare because of disability or other reasons.
Between 2012 and 2022 premature deaths in that age range rose by 27%. Nationwide the rate increased from 243 to 309 deaths per 100,000 adults. Black adults saw a larger rise — from 309 to 427 per 100,000 — while white adults went from 247 to 316 per 100,000. West Virginia had the highest early-death rate in 2022 and Massachusetts the lowest. Nearly every state showed higher early-death rates for Black Americans, except New Mexico, Rhode Island, and Utah.
Lead author Irene Papanicolas said many people "contribute to Medicare their entire lives yet never live long enough to use it," and coauthor Jose Figueroa noted the program design "effectively bakes structural inequity into a system that was meant to be universal." The authors suggest policymakers consider whether the timing of health coverage still matches when people need care. The findings appear in JAMA Health Forum and the study was supported by the National Institute on Aging; the source is Brown University.
Difficult words
- safety net — services that protect people from hardship
- payroll tax — tax taken from workers' paychecks by employerspayroll taxes
- enrollee — person registered to receive a program's servicesenrollees
- premature death — death that happens earlier than expectedpremature deaths
- eligible — having the right to receive something
- structural inequity — unfair system-level differences between groups
- policymaker — person who creates public rules or lawspolicymakers
Tip: hover, focus or tap highlighted words in the article to see quick definitions while you read or listen.
Discussion questions
- Why might paying payroll taxes for years but dying before age 65 be seen as an equity problem? Give reasons based on the article.
- How could policymakers assess whether the timing of health coverage matches when people need care? Suggest practical steps.
- The article notes state differences in early-death rates. What factors could explain why some states have higher rates than others?
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