We use large-scale federal survey data linked to administrative death records to investigate the relationship between Medicaid enrollment and mortality. Our analysis compares changes in mortality for near-elderly adults in states with and without Affordable Care Act Medicaid expansions. We identify adults most likely to benefit using survey information on socioeconomic status, citizenship status, and public program participation. We find that prior to the ACA expansions, mortality rates across expansion and nonexpansion states trended similarly, but beginning in the first year of the policy, there were significant reductions in mortality in states that opted to expand relative to nonexpanders. Individuals in expansion states experienced a 0.132 percentage point decline in annual mortality, a 9.4% reduction over the sample mean, as a result of the Medicaid expansions. The effect is driven by a reduction in disease-related deaths and grows over time. A variety of alternative specifications, methods of inference, placebo tests, and sample definitions confirm our main result.

Exploiting a discontinuity in childhood Medicaid eligibility based on date of birth, we find that more years of childhood eligibility are associated with fewer hospitalizations in adulthood. For blacks, we find a 7% to 15% decrease in hospitalizations and a suggestive 2% to 5% decrease in emergency department visits, but no similar effect for nonblacks. The effects are pronounced for utilization related to chronic illnesses and for patients living in low-income postal codes. Calculations suggest that lower rates of hospitalizations during one year in adulthood for blacks offset between 2% and 4% of the initial costs of expanding Medicaid for all children.

We use linked administrative data on the universe of California births to provide novel evidence on economic inequality in infant and maternal health. Infants and mothers at the top of the income distribution have worse birth and morbidity outcomes than their lowest-income counterparts, but are nevertheless the least likely to die in the year following birth. Racial disparities swamp these income disparities, with no racial convergence in health outcomes as income rises. A comparison with Sweden shows that infant and maternal health is worse in California at virtually all income levels.

We examine multi-generational impacts of positive in utero health interventions using a new research design that exploits sharp increases in prenatal Medicaid eligibility that occurred in some states. Our analyses are based on U.S. Vital Statistics Natality files, which enables linkages between individuals' early life Medicaid exposure and the next generation's health at birth. We find evidence that the health benefits associated with treated generations' early life program exposure extend to later offspring. Our results suggest that the returns on early life health investments may be substantively underestimated.

The Supplemental Security Income program uses a birth weight cutoff at 1,200 grams to determine eligibility. Using birth certificates linked to administrative records, we find low-income families of infants born just below the cutoff receive higher monthly cash benefits (equal to 27 percent of family income) at ages 0–2 with smaller benefits continuing through age 10. Yet we detect no improvements in health care use and mortality in infancy, nor in health and human capital outcomes as observed through young adulthood for these infants. We also find no improvements for their older siblings.