{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T22:44:30Z","timestamp":1787697870524,"version":"build-2784847793"},"reference-count":40,"publisher":"National Academy of Sciences","issue":"18","license":[{"start":{"date-parts":[[2024,4,22]],"date-time":"2024-04-22T00:00:00Z","timestamp":1713744000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100014822","name":"Notsew Orm Sands Foundation","doi-asserted-by":"publisher","award":["NA"],"award-info":[{"award-number":["NA"]}],"id":[{"id":"10.13039\/100014822","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Yale Burnett Endowment","award":["NA"],"award-info":[{"award-number":["NA"]}]},{"DOI":"10.13039\/100014822","name":"Notsew Orm Sands Foundation","doi-asserted-by":"publisher","award":["NA"],"award-info":[{"award-number":["NA"]}],"id":[{"id":"10.13039\/100014822","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.pnas.org"],"crossmark-restriction":true},"short-container-title":["Proc. Natl. Acad. Sci. U.S.A."],"published-print":{"date-parts":[[2024,4,30]]},"abstract":"<jats:p>In the absence of universal healthcare in the United States, federal programs of Medicaid and Medicare are vital to providing healthcare coverage for low-income households and elderly individuals, respectively. However, both programs are under threat, with either enacted or proposed retractions. Specifically, raising Medicare age eligibility and the addition of work requirements for Medicaid qualification have been proposed, while termination of continuous enrollment for Medicaid was recently effectuated. Here, we assess the potential impact on mortality and morbidity resulting from these policy changes. Our findings indicate that the policy change to Medicare would lead to over 17,000 additional deaths among individuals aged 65 to 67 and those to Medicaid would lead to more than 8,000 deaths among those under the age of 65. To illustrate the implications for morbidity, we further consider a case study among those people with diabetes who would be likely to lose their health insurance under the policy changes. We project that these insurance retractions would lead to the loss of coverage for over 700,000 individuals with diabetes, including more than 200,000 who rely on insulin.<\/jats:p>","DOI":"10.1073\/pnas.2321494121","type":"journal-article","created":{"date-parts":[[2024,4,22]],"date-time":"2024-04-22T15:06:28Z","timestamp":1713798388000},"update-policy":"https:\/\/doi.org\/10.1073\/pnas.cm10313","source":"Crossref","is-referenced-by-count":3,"title":["Mortality and morbidity ramifications of proposed retractions in healthcare coverage for the United States"],"prefix":"10.1073","volume":"121","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4578-7487","authenticated-orcid":false,"given":"Abhishek","family":"Pandey","sequence":"first","affiliation":[{"name":"Epidemiology of Microbial Diseases, Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5248-2668","authenticated-orcid":false,"given":"Meagan C.","family":"Fitzpatrick","sequence":"additional","affiliation":[{"name":"Epidemiology of Microbial Diseases, Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510"},{"name":"Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21201"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5295-5971","authenticated-orcid":false,"given":"Burton H.","family":"Singer","sequence":"additional","affiliation":[{"name":"Department of Mathematics, Emerging Pathogens Institute, University of Florida, Gainesville, FL 32610"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison P.","family":"Galvani","sequence":"additional","affiliation":[{"name":"Epidemiology of Microbial Diseases, Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510"},{"name":"Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21201"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"341","published-online":{"date-parts":[[2024,4,22]]},"reference":[{"key":"e_1_3_4_1_2","article-title":"Raising Medicare\u2019s eligibility age would increase overall health spending and shift costs to seniors, states, and employers","author":"Van de Water P. 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Dewitz Photography | Eau Claire, Wis Portrait Photographer (2012) (17 November 2023).","journal-title":"Dewitz Photography | Eau Claire, Wis Portrait Photographer"},{"key":"e_1_3_4_5_2","unstructured":"United States Census Bureau Communications Directorate - Center for New Media QuickFacts: McDowell County West Virginia. https:\/\/www.census.gov\/quickfacts\/fact\/table\/mcdowellcountywestvirginia phillipscountyarkansas holmescountymississippi\/PST045222. Accessed 17 November 2023."},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1257\/pol.20140262"},{"key":"e_1_3_4_7_2","unstructured":"Congressional Budget Office Age of eligibility for Medicare to 67. https:\/\/www.cbo.gov\/budget-options\/54733. 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Accessed 16 September 2023."},{"key":"e_1_3_4_14_2","unstructured":"Kaiser Family Foundation Medicaid income eligibility limits for adults as a percent of the federal poverty level (Kaiser Family Foundation 2023). https:\/\/www.kff.org\/affordable-care-act\/state-indicator\/medicaid-income-eligibility-limits-for-adults-as-a-percent-of-the-federal-poverty-level\/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22 %22sort%22:%22asc%22%7D. Accessed 25 July 2023."},{"key":"e_1_3_4_15_2","article-title":"A state-by-state guide to Medicaid: Do I qualify?","author":"Skowronski J.","year":"2018","unstructured":"J. Skowronski, A state-by-state guide to Medicaid: Do I qualify? Policygenius (2018) (4 August 2023).","journal-title":"Policygenius"},{"key":"e_1_3_4_16_2","article-title":"A closer look at the remaining uninsured population eligible for Medicaid and CHIP","author":"Tolbert J.","year":"2023","unstructured":"J. Tolbert, P. Drake, R. Rudowitz, A. Damico, A closer look at the remaining uninsured population eligible for Medicaid and CHIP. KFF (2023) (11 August 2023).","journal-title":"KFF"},{"key":"e_1_3_4_17_2","unstructured":"The Center for Medicaid and CHIP Services Unwinding and returning to regular operations after COVID-19. https:\/\/www.medicaid.gov\/resources-for-states\/coronavirus-disease-2019-covid-19\/unwinding-and-returning-regular-operations-after-covid-19\/index.html. Accessed 14 August 2023."},{"key":"e_1_3_4_18_2","unstructured":"COE\u2013educational attainment in rural areas. https:\/\/nces.ed.gov\/programs\/coe\/indicator\/lbc\/educational-attainment-rural?tid=1000. Accessed 23 January 2024."},{"key":"e_1_3_4_19_2","unstructured":"Lack of internet access hinders rural America\u2019s education and economic opportunities (2021) https:\/\/oversight.house.gov\/release\/lack-of-internet-access-hinders-rural-americas-education-and-economic-opportunities\/. Accessed 2 December 2023."},{"key":"e_1_3_4_20_2","unstructured":"Kaiser Family Foundation Medicaid Enrollment and Unwinding Tracker\u2013Overview. Kaiser Family Foundation (2024). https:\/\/www.kff.org\/report-section\/medicaid-enrollment-and-unwinding-tracker-overview\/. Accessed 6 November 2023."},{"key":"e_1_3_4_21_2","article-title":"States\u2019 varying approaches complicate effort to determine impact of Medicaid redeterminations","author":"Olsen E.","year":"2023","unstructured":"E. Olsen, R. Pifer, States\u2019 varying approaches complicate effort to determine impact of Medicaid redeterminations. Healthcare Dive (2023) (6 November 2023).","journal-title":"Healthcare Dive"},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2023.00325"},{"key":"e_1_3_4_23_2","article-title":"CBO: Medicaid work requirement would leave 600,000 uninsured","author":"Muoio D.","year":"2023","unstructured":"D. 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Arias, Mortality in the United States, 2021. NCHS Data Brief, 1\u20138 (2022).","journal-title":"NCHS Data Brief"},{"key":"e_1_3_4_40_2","unstructured":"U.S. Census Bureau Explore Census Data. https:\/\/data.census.gov\/table?q=health+insurance&tid=ACSST5Y2021.S2701. 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