When Shailender Swaminathan and his Brown University research team looked at dialysis patients in their late teens and early twenties, they discovered something that might seem obvious but is rarely proven so clearly: health insurance literally saves lives. Their new study, published in JAMA Pediatrics, found that the Medicaid expansion triggered by the Affordable Care Act in 2010 reduced one-year death rates among young adults starting dialysis—a population facing health odds that would seem almost impossible to improve.
The context matters. Young adults with kidney failure are among the sickest patients in medicine: their risk of dying from heart disease is 500 times higher than that of their healthy peers. Before the Affordable Care Act, nearly one in three young adults aged 19 to 25 lacked any health insurance at all, locked out by the loss of childhood Medicaid eligibility at 19 and stuck in jobs that rarely offered coverage. The policy shift was dramatic: uninsurance rates for that age group plummeted from 31.5% in 2009 to just 13.1% in 2023—the largest improvement across any age group in America.
The research team studied 7,139 young dialysis patients between 2010 and 2019, comparing those aged 19 to 23, who gained coverage through Medicaid expansion, with younger adolescents aged 14 to 18, whose insurance status remained unchanged. The difference was measurable and statistically significant: one-year mortality among the newly insured group declined by 1.8 percentage points. That might sound small, but when translated across a population facing such severity of illness, it represents lives saved—fewer young people dying in their first year on dialysis.
The mechanism was straightforward. With insurance in place, young adults received better pre-dialysis care, meaning their kidneys were managed before failure became catastrophic. They started dialysis sooner and received longer, more frequent sessions—interventions that directly improve survival and reduce hospital complications. These aren't flashy innovations or cutting-edge therapies; they're the bread-and-butter of good medical practice, and they had simply been out of reach for uninsured young people.
Dr. Amal Trivedi, a professor at Brown's School of Public Health and co-author of the study, chose to publish this finding now for a reason. Between 5 million and 10 million Americans are projected to lose Medicaid coverage by 2028 following new federal legislation signed in July 2025. As policy makers grapple with coverage decisions, the evidence is clear: for people with serious, ongoing medical needs, health insurance isn't a luxury or a lifestyle choice—it's the difference between dying and surviving.
Swaminathan put it plainly: "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." The Medicaid expansion didn't introduce new medications or revolutionary treatments. It simply ensured that young people with kidney failure could see a doctor without financial catastrophe, and that change—that single policy shift—extended their lives.