diff --git a/domains/health/Americas declining life expectancy is driven by deaths of despair concentrated in populations and regions most damaged by economic restructuring since the 1980s.md b/domains/health/Americas declining life expectancy is driven by deaths of despair concentrated in populations and regions most damaged by economic restructuring since the 1980s.md
index 887a2e1f..122ac4d3 100644
--- a/domains/health/Americas declining life expectancy is driven by deaths of despair concentrated in populations and regions most damaged by economic restructuring since the 1980s.md	
+++ b/domains/health/Americas declining life expectancy is driven by deaths of despair concentrated in populations and regions most damaged by economic restructuring since the 1980s.md	
@@ -28,6 +28,12 @@ As Steven Woolf, the study's lead author, puts it: "this is an emergent crisis.
 
 This data powerfully validates [[the epidemiological transition marks the shift from material scarcity to social disadvantage as the primary driver of health outcomes in developed nations]]. The US is the richest country in the world spending more on healthcare than any other nation, yet ranks in the mid-40s globally in life expectancy alongside Lebanon, Cuba, and Chile. The problem is not material -- it is psychosocial, and the current healthcare system is structurally incapable of addressing it because it treats symptoms not causes.
 
+
+### Additional Evidence (extend)
+*Source: [[2026-03-20-annals-internal-medicine-obbba-health-outcomes]] | Added: 2026-03-20*
+
+OBBBA adds a second mechanism for US life expectancy decline: policy-driven coverage loss (16,000+ preventable deaths annually, per Annals of Internal Medicine peer-reviewed study). This mechanism compounds deaths of despair because the populations losing Medicaid coverage heavily overlap with deaths-of-despair populations (rural, economically restructured regions). The mortality signal will appear in 2028-2030 data as a distinct but interacting pathway.
+
 ---
 
 Relevant Notes:
diff --git a/inbox/queue/.extraction-debug/2026-03-20-annals-internal-medicine-obbba-health-outcomes.json b/inbox/queue/.extraction-debug/2026-03-20-annals-internal-medicine-obbba-health-outcomes.json
new file mode 100644
index 00000000..375da562
--- /dev/null
+++ b/inbox/queue/.extraction-debug/2026-03-20-annals-internal-medicine-obbba-health-outcomes.json
@@ -0,0 +1,34 @@
+{
+  "rejected_claims": [
+    {
+      "filename": "obbba-medicaid-cuts-project-16000-preventable-deaths-annually-through-coverage-loss-mechanism.md",
+      "issues": [
+        "missing_attribution_extractor",
+        "opsec_internal_deal_terms"
+      ]
+    },
+    {
+      "filename": "obbba-projects-100-plus-rural-hospital-closures-creating-healthcare-infrastructure-collapse-in-medicaid-dependent-regions.md",
+      "issues": [
+        "missing_attribution_extractor"
+      ]
+    }
+  ],
+  "validation_stats": {
+    "total": 2,
+    "kept": 0,
+    "fixed": 2,
+    "rejected": 2,
+    "fixes_applied": [
+      "obbba-medicaid-cuts-project-16000-preventable-deaths-annually-through-coverage-loss-mechanism.md:set_created:2026-03-20",
+      "obbba-projects-100-plus-rural-hospital-closures-creating-healthcare-infrastructure-collapse-in-medicaid-dependent-regions.md:set_created:2026-03-20"
+    ],
+    "rejections": [
+      "obbba-medicaid-cuts-project-16000-preventable-deaths-annually-through-coverage-loss-mechanism.md:missing_attribution_extractor",
+      "obbba-medicaid-cuts-project-16000-preventable-deaths-annually-through-coverage-loss-mechanism.md:opsec_internal_deal_terms",
+      "obbba-projects-100-plus-rural-hospital-closures-creating-healthcare-infrastructure-collapse-in-medicaid-dependent-regions.md:missing_attribution_extractor"
+    ]
+  },
+  "model": "anthropic/claude-sonnet-4.5",
+  "date": "2026-03-20"
+}
\ No newline at end of file
diff --git a/inbox/queue/2026-03-20-annals-internal-medicine-obbba-health-outcomes.md b/inbox/queue/2026-03-20-annals-internal-medicine-obbba-health-outcomes.md
index 1996da3f..3f287179 100644
--- a/inbox/queue/2026-03-20-annals-internal-medicine-obbba-health-outcomes.md
+++ b/inbox/queue/2026-03-20-annals-internal-medicine-obbba-health-outcomes.md
@@ -7,9 +7,13 @@ date: 2025-07-01
 domain: health
 secondary_domains: []
 format: peer-reviewed study
-status: unprocessed
+status: enrichment
 priority: high
 tags: [obbba, medicaid, preventable-deaths, health-outcomes, coverage-loss, rural-hospitals]
+processed_by: vida
+processed_date: 2026-03-20
+enrichments_applied: ["Americas declining life expectancy is driven by deaths of despair concentrated in populations and regions most damaged by economic restructuring since the 1980s.md"]
+extraction_model: "anthropic/claude-sonnet-4.5"
 ---
 
 ## Content
@@ -54,3 +58,13 @@ Peer-reviewed study in Annals of Internal Medicine modeling the health consequen
 PRIMARY CONNECTION: [[Americas declining life expectancy is driven by deaths of despair concentrated in populations and regions most damaged by economic restructuring since the 1980s]]
 WHY ARCHIVED: Documents a second mechanism for US life expectancy decline — now policy-driven coverage loss in addition to deaths of despair. These mechanisms interact: the populations losing Medicaid are heavily overlapping with deaths-of-despair populations.
 EXTRACTION HINT: Extractor should create TWO claims: (1) OBBBA coverage loss mortality mechanism (16,000 deaths, peer-reviewed), (2) rural hospital closure projection (infrastructure collapse claim). Don't conflate them.
+
+
+## Key Facts
+- OBBBA passed July 4, 2025
+- CBO final score projects 10 million coverage loss by 2034
+- Study projects 380,000 missed mammograms annually
+- Study projects 1.2 million people accruing additional medical debt
+- Study projects $7.6 billion in new total medical debt nationally
+- Study projects $135 billion economic contraction over 10 years
+- Study projects 300,000+ jobs lost over 10 years