Insurance rates skyrocketed after Obamacare launched in 2010. How about life expectancy?
With uninsured rates nearing record lows according to a new report, HealthCare.com looked at whether higher health insurance rates led to changes in life expectancy across all 50 U.S. states.
We analyzed data from official sources and discovered that while there was an increase in the rate of insured Americans following the passage of the Affordable Care Act (“Obamacare”), that increase didn’t necessarily correlate to longer lifespans across the board.
Across all 50 states, 91.6% of the population was insured as of 2019 — a significant rise from the national health insurance rate of 85.8% in 2010. As of 2019, average life expectancy in the U.S. was 78.7 years across all 50 states. This does not suggest a significant increase from 2010, when the average life expectancy was 78.5.
Key Findings
Despite a positive correlation between health insurance and life expectancy, some states saw a decrease in lifespans following the passage of the Affordable Care Act in 2010.
The state with the highest health insurance rate as of 2019 was Massachusetts, at 97% insured.
Nevada saw the most growth in health insurance rates between 2010 and 2019, gaining 11.6% from 77% to 88.6%.
As of 2019, the state where residents have the longest life expectancy is Hawaii, at 82.3 years.
Washington D.C. saw the greatest gain in life expectancy at 2.1 years from 2010-2019.
Washington D.C. also saw the greatest gain in life expectancy relative to insurance rates. Residents enjoyed a 0.51-year gain in life expectancy per 1% gain in insurance rates.
Ohio and West Virginia both saw decreases of 0.7 years in life expectancy between 2010 and 2019.
Link between health insurance and life expectancy varies widely by state
Looking at national data, there is a generally positive if not strong statistical correlation between health insurance rates and life expectancy. But individual states are a different story.
The state with the highest health insurance rate as of 2019 is Massachusetts, at 97% insured. When looking at data from 2010, Massachusetts also came in on top at 95.6%. This high rate of insurance may be linked in part to the Massachusetts 2006 healthcare reform, which has been called a model for the Affordable Care Act.
According to research published in the Annals of Internal Medicine, the law attained near-universal insurance coverage and increased access to care. The 2014 study found that the law was associated with a significant decrease in all-cause mortality and deaths from causes amenable to healthcare.
For rates of insurance in 2019, Massachusetts is trailed by the District of Columbia (96.5%), Rhode Island (95.9%), Hawaii (95.8%), Vermont (95.5%), Minnesota (95.1%), and Iowa (95%). Rounding out the top 10 are New York (94.8%), Wisconsin (94.3%), and Pennsylvania (94.2%).
Which states saw the biggest changes in health insurance rates?
Although Massachusetts has the highest rate of insured residents, it only tied in sixth place for longest life expectancy in 2019. The top honor went to Hawaii, where the average life expectancy was 82.3 years. California came in second with an average life expectancy of 81.7 years — despite not cracking the top 10 when it comes to states with the highest health insurance rates.
Research suggests there may be other important factors at play besides health insurance that contribute to residents in states like Hawaii and California having longer lifespans.
“The thing to keep in mind when considering life expectancy is that there isn’t just one trend – there are many, many different trends in different parts of the U.S., and among different segments of the population, for example among racial/ethnic groups, or individuals with different levels of education,” Laura Dwyer-Lindgren, an Assistant Professor of Health Metrics Sciences at the University of Washington’s Institute for Health Metrics and Evaluation, told HealthCare.com.
A 2020 study published in the Milbank Quarterly examined discrepancies in life expectancy between different states. Their findings suggested that residents who live in states with more liberal policies tend to enjoy longer lifespans than those who live in states with more conservative policies. Researchers wrote, “U.S. life expectancy is estimated to be 2.8 years longer among women and 2.1 years longer among men if all states enjoyed the health advantages of states with more liberal policies.”
Additional research published in the Journal of the American Medical Association finds that inequalities in life expectancy can largely be attributed to socioeconomic and race/ethnicity factors as well as behavioral and metabolic risk factors, though they also found that healthcare factors do play a part.
When it comes to life expectancy, New York (81.4), Minnesota (80.9), Connecticut (80.9), Massachusetts (80.6), and Colorado (80.6) trail behind Hawaii and California. Rounding out the top 10 states with the highest life expectancies are New Jersey (80.5), Washington (80.4), and Florida (80.2).
Following the implementation of the Affordable Care Act in 2010, the rate of insured residents rose in all U.S. states. Some states saw more of an increase than others. Nevada saw the most growth in health insurance between 2010 and 2019, going from 77% to 88.6%, a change of 11.2 percentage points. None saw a drop in health insurance rates following the passage of the ACA, but Massachusetts saw the smallest bump, going from 95.6% to 97% insured.
Which states saw the biggest changes in life expectancy?
While common sense might suggest that increasing the rate of Americans with health insurance via the Affordable Care Act would lead to a similar increase in life expectancy across the board, data suggests otherwise.
Ohio and West Virginia both saw decreases of 0.7 years in life expectancy between 2010 and 2019. Though there may be multiple reasons for this, one significant potential factor is likely the opioid epidemic.
West Virginia has experienced the worst of the opioid crisis. A study from the American Journal of Public Health looked at data from 2008 to 2016 and found that during this time, the opioid overdose death rate for the state increased more than 107%, from 21.0 per 100 000 in 2008 to 43.4 per 100,000 in 2016, an average annual percentage increase of 12%.
Similarly, research published in Scientific Reports found that Ohio was one of eight states with a doubling of the opioid mortality rate every three years from 1999 to 2016. The researchers reported a 169% increase from 1,544 opioid overdose deaths in 2010 to 4,157 deaths in 2017. As of 2018, Ohio experienced 35.9 opioid overdose deaths per 100,000 inhabitants.
The Centers for Disease Control points to drug overdoses as a leading cause in decreased life expectancy. In 2018, Robert R. Redfield, M.D., CDC Director issued a statement about U.S. life expectancy declining, saying, “This troubling trend is largely driven by deaths from drug overdose and suicide.”
In the data we analyzed, New Hampshire saw a decrease of 0.6 years. Maine, Indiana, and South Dakota all saw decreases of 0.4 years.
While Nevada saw the most growth in health insurance rates, it wasn’t the state that saw the most growth in life expectancy over the decade.
The District of Columbia experienced a 2.1 year increase in life expectancy, outpacing all others. D.C. is followed by Florida, which saw a 1.2 year rise between 2010 and 2019.
Washington D.C. also enjoyed the greatest gain in life expectancy relative to the increase in insurance rates. For every one percent gain in health insurance, D.C. residents enjoyed a 0.51-year, or six-month, gain in life expectancy.
Maine, on the other hand, saw the biggest drop in life expectancy relative to its increase in insurance rates. For every one percent gain in health insurance, Down Easters lost 0.19 years, or almost 10 weeks, in life expectancy.
Which states saw the biggest changes in life expectancy per one percent rise in health insurance rates?
Northeast has highest insured rate and life expectancy
As of 2019, the Northeast has the highest insured rate, with 94.3% insured. The Northeast also has the highest life expectancy at 79.9 years, although the Western U.S. is nearly tied at 79.8 years.
Between 2010 and 2019, the West saw the most growth in the rate of insured residents with growth of 7.5%. The South also saw an increase of 6%, more than the Midwest (4.4%) and Northeast (4.3%).
No region saw a drop in the rate of insured, though the Northeast saw the smallest increase — potentially because the Northeast had the highest insured rate to begin with, at 89.9% in 2010.
During the same time period, the West also saw the most growth in life expectancy, with an increase of 0.5 years. The South saw an increase of 0.3 years, while the Northeast stayed virtually stagnant at 0.08 years.
The Midwest saw a very small drop in life expectancy of 0.1 years between 2010 and 2019.
