Opinion: What the 2024 electoral map reveals about America’s mortality divide — SkimNews
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- UCSF researchers found 2024 age-adjusted mortality at 774 deaths per 100,000 in states that voted for Trump versus 649 in states that voted for Harris — a 19.2% gap — as health care ranked third on voters' minds in the 2026 midterms.
- Republican-plurality counties widened their mortality disadvantage from just 2% in 2001 to 16.1% by 2019, with mortality falling 11.1% there versus 21.9% in Democratic-plurality counties over that span.
- COVID-19 explains part but not all of the gap: mortality peaked at 86 per 100,000 in 2020 in Harris-voted states while Trump-voted states kept climbing to 122 per 100,000 in 2021, and the all-cause gap in 2024 was modestly narrower than in 2021.
- Heart disease mortality fell 9.1% in Harris-voted states from 2016 to 2024 but only 2.9% in Trump-voted states, while cancer deaths fell 12.9% versus 9.1%, pointing to chronic disease rather than the pandemic alone.
- Drug overdose mortality ran the other way: 18% (3.4 per 100,000) higher in Trump-voted states in 2016, but an estimated 2% (0.4 per 100,000) higher in Harris-voted states by 2024, falling below in 2023 after peaks of 35 per 100,000 in 2021 for Trump states and 32.5 in 2022 for Harris states.
- Medicaid expansion has not been adopted by 10 states, and all 10 voted for Trump in 2024; those non-expansion states also saw greater coverage losses during Medicaid unwinding, with work requirements and reverification cited as further affecting coverage continuity.
- Rural communities, which have historically voted Republican, face disproportionate hospital closures, and the authors call for expanded affordable care, closing educational gaps, rural and behavioral health infrastructure, and rebuilding trust rather than treating red and blue states as fixed categories of health risk.
Why it matters: The 10 non-expansion states that all voted Trump already carry the slower chronic-disease gains, and they also lost more coverage during Medicaid unwinding. But overdose deaths have reversed course and are now slightly higher in Harris states, so any health push framed as one uniform red-state mortality problem would miss a divide that is cause-specific, not uniform.
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