A study by researchers at Brown University and Harvard University shows that a rising premature death rate means Medicare isn't helping as many people as intended.
PROVIDENCE, R.I. [Brown University] - For 60 years, Medicare has served as a social safety net. Workers pay into the system over their lifetimes with the expectation that they will be able to access affordable health care when they turn 65. But for a growing number of Americans, especially Black Americans, that expectation is going unfulfilled.
That's according to a new study led by researchers at Brown University and Harvard University, which found that a rising number of premature deaths prevent many Americans from reaching the age of Medicare eligibility. From 2012 to 2022, deaths among adults ages 18 to 64 increased by 27%, according to an analysis of federal mortality data from all 50 states.
The trend is especially true for Black adults, who saw a 38% increase in premature deaths over the decade, compared with a 28% rise among white Americans. The findings were published in JAMA Health Forum.
"These are people who contribute to Medicare their entire lives yet never live long enough to use it," said lead author Irene Papanicolas, a professor of health services, policy and practice at the Brown University School of Public Health. "When you look through the lens of race, it's clear that one group is increasingly dying before they ever see the benefits of the system they helped fund."
Created in 1965, Medicare is primarily funded through payroll taxes and covers nearly all Americans 65 and older. Today, about 69 million people, most of them seniors, are enrolled in the program. But new data from the study shows shorter lives are translating into unequal access to this public benefit.
To understand who dies before qualifying for coverage, the research team analyzed Medicare enrollment files and death records from the U.S. Centers for Disease Control and Prevention. They counted all deaths among adults ages 18 to 64 in every state from 2012 to 2022 then subtracted those already eligible for Medicare due to disability or other reasons.
Because of inconsistencies in how race and ethnicity are recorded across federal systems, the researchers were only able to analyze data for the population groups of Black and white adults.
Nationwide, premature deaths rose from 243 per 100,000 adults in 2012 to 309 in 2022. Black adults consistently faced higher rates of early death than white adults. In 2012, the rate was 309 deaths per 100,000 for Black adults and 247 for white adults. By 2022, those figures climbed to 427 and 316 per 100,000 deaths.
Among all groups, West Virginia had the highest rate of premature deaths in 2022, while Massachusetts had the lowest. Nearly every state showed higher rates of early death among Black Americans, with only New Mexico, Rhode Island and Utah showing no statistically meaningful racial difference.
"Because premature mortality disproportionately affects Black Americans, the current design of the Medicare program effectively bakes structural inequity into a system that was meant to be universal," said Jose Figueroa, co-author of study and an associate professor of health policy at Harvard University. "What's most troubling is that these inequities aren't shrinking - they're deepening across nearly every state."
The findings come at a time when U.S. life expectancy has been falling for much of the past decade, even among wealthier Americans who typically live longer than the poorest Americans, Papanicolas said. There has also been a rise in preventable deaths, she said, which has been partly driven by rising deaths in midlife, generally defined as between the ages of 40 and 65.
"What we're increasingly seeing is that Americans have increased health needs during midlife," Papanicolas said. "Which raises the question for policymakers: Does the system still work if more people are getting sick and dying before the age of 65?"
The study authors pointed out that while the U.S. population is older than ever with the current number of Americans ages 65 and older projected to increase, the timing of health coverage no longer aligns with when many Americans need it the most.
"Even when people die before they can access the care they pay for, that money still stays in Medicare," Papanicolas said. "Moving forward, aligning health care access to need - not just to age - should be a policy imperative."
The study was supported by the National Institute of Aging (grant RF1-AG088640).
