Expanding Medicaid coverage under the Affordable Care Act was linked to a significant drop in death rates among young adults with kidney failure, according to new research led by Brown University. The findings carry urgent relevance as millions of Americans face potential Medicaid cuts.
Young adults with kidney failure were significantly less likely to die within a year of starting dialysis after Medicaid was expanded under the Affordable Care Act, according to a new study from Brown University published in JAMA Pediatrics.
The research, which tracked 7,139 patients between 2010 and 2019, found that one-year mortality rates among 19- to 23-year-olds who began dialysis declined by a statistically significant 1.8 percentage points following Medicaid expansion. Researchers compared that age group — newly eligible under expanded coverage — to adolescents ages 14 to 18, whose Medicaid eligibility was unchanged.
“The biggest takeaway from this study is that health insurance is critically important for survival among individuals with a high and constant need for medical care,” lead author Shailender Swaminathan, an adjunct professor of health services, policy and practice at the Brown University School of Public Health, said in a news release.
Kidney failure is an especially dangerous condition for young adults. Their risk of dying from heart disease is 500 times greater than that of their healthy peers of the same age — making access to consistent, high-quality care a matter of life and death.
Why Young Adults Were a Key Focus
Before the ACA took effect, young adults carried the highest uninsurance rates of any age group in the country — a consequence of aging out of childhood Medicaid eligibility at 19 and working jobs that rarely offer health benefits. The ACA addressed this in two major ways: it expanded Medicaid to cover more low-income adults, and it required insurers to keep dependents on a parent’s plan until age 26.
The results were dramatic. Uninsurance rates for 19- to 25-year-olds plummeted from 31.5% in 2009 to 13.1% in 2023 — the largest decline of any age group in the U.S.
“Young adults have historically been underinsured, but the Medicaid expansions under the Affordable Care Act were able to address that issue quite quickly,” Swaminathan added. “Thus, we were able to find a large shift in health insurance coverage for young adults before and after Medicaid expansions. Second, unlike for older adults, benefits of Medicaid for young adults can potentially accrue over multiple years.”
For young adults with kidney failure specifically, expanded coverage translated into concrete improvements in care: better pre-dialysis preparation, increased dialysis use and longer treatment sessions — all of which are associated with improved long-term outcomes.
Context: Medicaid Cuts on the Horizon
The findings land at a politically charged moment. Between 5 million and 10 million Americans are projected to lose Medicaid coverage by 2028 under H.R. 1 — known as the One Big Beautiful Bill Act — signed into law in July 2025. That prospect makes the Brown team’s conclusions especially pointed.
Senior author Amal Trivedi, a professor of health services, policy and practice at Brown, stressed the policy stakes directly.
“As we approach these issues, it’s important to keep in mind that Medicaid expansion was associated with substantial reductions in mortality among young adults with kidney failure initiating dialysis,” Trivedi said in the news release. “This suggests that expanded health insurance coverage may improve survival and care quality in this high-risk population.”
For college students and young professionals — a demographic already navigating uncertain employment, rising costs and gaps in employer-provided benefits — the study underscores how quickly coverage gaps can become life-threatening for those managing serious chronic conditions.
Source: Brown University