For 60 years, Medicare has served as a social safety net. Workers pay into the system throughout their lives with the expectation that they will have access to affordable health care when they turn 65. But for a growing number of Americans, especially Black Americans, that expectation is not being met.
That’s according to a new study led by researchers at Brown University and Harvard University, which found that a growing number of premature deaths are preventing many Americans from reaching Medicare eligibility age. From 2012 to 2022, deaths among adults ages 18 to 64 increased 27 percent, according to an analysis of federal mortality data from all 50 states.
The trend is especially true for black adults, who saw a 38 percent increase in premature deaths over the decade, compared to a 28 percent increase among white Americans. The findings were published in JAMA Health Forum.
These are people who contribute to Medicare their entire lives but never live long enough to use it. When you look through the lens of race, it’s clear that one group is increasingly dying before ever seeing the benefits of the system they helped fund.”
Irini Papanikola, lead author, professor of health services, policy and practice at Brown University School of Public Health
Created in 1965, Medicare is funded primarily through payroll taxes and covers nearly all Americans age 65 and older. Today, about 69 million people, most of them elderly, are enrolled in the program. But new data from the study shows that shorter lives translate into unequal access to this public benefit.
To understand who dies before qualifying for coverage, the research team analyzed Medicare enrollment records and death records from the US Centers for Disease Control and Prevention. They counted all deaths among adults ages 18 to 64 in each state from 2012 to 2022, then removed those who were already eligible for Medicare because of disability or other reasons.
Because of inconsistencies in how race and ethnicity are recorded in federal systems, the researchers were only able to analyze data for the population groups of black and white adults.
Nationally, premature deaths increased from 243 per 100,000 adults in 2012 to 309 in 2022. Black adults experienced consistently higher rates of premature 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 numbers had risen 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. Almost every state showed higher premature death rates among Black Americans, with only New Mexico, Rhode Island, and Utah showing no statistically significant racial difference.
“Because premature mortality disproportionately affects black Americans, the current design of the Medicare program essentially builds structural inequality into a system that was intended to be universal,” said Jose Figueroa, study co-author and associate professor of health policy at Harvard University. “What’s more troubling is that these disparities aren’t shrinking — they’re deepening in almost every state.”
The findings come at a time when life expectancy in the U.S. has been declining for much of the past decade, even among the wealthiest Americans who typically live longer than the poorest Americans, Papanikolas said. There has also been an increase in preventable deaths, he said, which is partly due to an increase in deaths in middle age, generally defined as ages between 40 and 65.
“What we’re increasingly seeing is that Americans have increased health needs in midlife,” Papanikolas said. “Which raises the question for policymakers: Does the system still work if more people get sick and die before age 65?”
The study’s authors noted that while the U.S. population is larger than ever, with the current number of Americans age 65 and older expected to increase, the timing of health coverage no longer aligns with when many Americans need it most.
“Even when people die before they can access the care they’re paying for, that money still stays in Medicare,” Papanikolas said. “Moving forward, aligning access to health care with need — not just age — should be a policy imperative.”
The study was supported by the National Institute on Aging (grant RF1-AG088640).
