Suicide rates slow in states that expanded Medicaid: study

“With the differences we see in these suicide rates, we think there must actually be significantly more treatment, as well as subsequent improvements, in mental health in the states with expanded Medicaid.”

by Gianna Melillo | Jun. 15, 2022

The Associated Press/Jacquelyn Martin

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Suicide rates have been steadily increasing in the U.S. since 1999.

Rising prevalence of mental health disorders along with a relative shortage of providers compound this epidemic.

But new research reveals Medicaid expansion under the Affordable Care Act was associated with hundreds of fewer suicide deaths over a period of four years.

Suicide remains one of the leading causes of death in the United States and is second only to unintentional injury among those aged 10 through 34.

Increased reports of anxiety, depression and mental health disorders fuel concern this epidemic will grow in coming years, exacerbated by widespread shortages of mental health care providers.

Although this shortage was not necessarily anticipated in 2010 when congress passed the Affordable Care Act (ACA), it is true that increased access to care leads to better health outcomes. Following a Supreme Court case in 2012, states were eligible to expand their Medicaid programs beginning in 2014.

As of June 2022, 39 states and Washington, D.C., have expanded Medicaid coverage under the ACA, broadening access to nearly all adults who earn up to 138 percent of the federal poverty level, according to a Kaiser Family Foundation tracker.

Medicaid expansion has been associated with numerous health benefits in the past, including reductions in racial disparities in breast cancer mortality and fewer cardiovascular-related deaths.

Past studies have also pointed to increased insurance coverage among patients with substance use disorder and mental illnesses since expansion was adopted.

Now, new research shows Medicaid expansion is associated with a statistically significant reduction in suicide rates compared with those reported in states that did not expand Medicaid.

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Looking at population-level data collected between 2000 and 2018, investigators in St. Louis compared age-adjusted suicide mortality rates based on state of residence.

Of the 553,912 suicides that took place within the study window, most occurred in white male individuals — a finding indicative of pervasive deaths of despair.

Although suicide rates continued to increase in both sets of states, smaller increases were seen after 2014 in states that did expand Medicaid (2.56 per 100,000 increase) than those that did not (3.10 per 100,000 increase).

Overall, researchers found 0.4 fewer suicides per 100,000 people in states that did expand Medicaid between 2014 and 2018, equating to an estimated 1,818 deaths averted.

“Suicide is a public health problem, and our findings indicate that increasing access to health care — including mental health care — by expanding Medicaid eligibility can play an important role in addressing and reducing the distressing rise of suicide deaths in our country,” said study co-author Laura J. Bierut in a press release.

Between 1999 and 2006, suicides have increased by an average of 1 percent each year. From 2006 through 2018, that average rose to 2 percent. Medical expenditures and work-loss costs from suicide amount to more than $4 billion annually in the U.S.