Medicaid Expansion and Firearm Suicide Mortality Among Black and White Men: A State-Level Retrospective Study, United States, 2000-2023.

Objectives. To examine whether the Affordable Care Act's Medicaid expansion was associated with changes in firearm suicide among Black and White men, recognizing that masculine norms such as self-reliance and reluctance to seek mental health care may shape how policy interventions influence men's health. Methods. We conducted a retrospective state-level analysis of firearm suicide mortality from 2000 to 2023 among US men aged 18 to 64 years. Difference-in-differences (DID) and synthetic DID models estimated changes in firearm suicide rates before and after Medicaid expansion after adjustment for sociodemographic and policy covariates. Results. Medicaid expansion was associated with a reduction of approximately 1.4 deaths per 100 000 among White men aged 35 to 49 years (95% confidence interval = -2.45, -0.39), but no consistent effects were observed for other groups. Firearm suicide increased across all subgroups, with the sharpest rises among younger Black men in both expansion and nonexpansion states. Conclusions. Medicaid expansion alone was insufficient to offset the drivers of men's firearm suicide risk. Reducing firearm suicides requires strategies combining expanded health coverage and approaches that challenge harmful masculine norms, advance racial equity, and reduce access to lethal means. (Am J Public Health. 2026;116(8):1095-1103. https://doi.org/10.2105/AJPH.2026.308581).