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The Effect of Public Insurance Expansions on Substance Use Disorder Treatment: Evidence from the Affordable Care Act

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  • Maclean, J. Catherine

    (Temple University)

  • Saloner, Brendan

    (Johns Hopkins University)

Abstract

We examine the early effects of U.S. state Medicaid expansions under the Affordable Care Act (ACA) on substance use disorder (SUD) treatment utilization. We couple administrative data on admissions to specialty SUD treatment and prescriptions for medications used to treat SUDs in outpatient settings with a differences-in-differences design. We find no evidence that admissions to specialty treatment changed in expanding states relative to non-expending states. However, post expansion, Medicaid-reimbursed prescriptions for medications used to treat SUDs in outpatient settings increased by 33% in expanding states relative to non-expanding states. Among patients admitted to specialty SUD treatment, we find that in expanding states Medicaid insurance and use of Medicaid to pay for treatment increased by 58% and 57% following the expansion. In an extension to the main analyses we find no evidence that the expansions affected fatal alcohol poisonings or drug-related overdoses. Overall, our findings provide evidence on the early effects of the ACA on SUD treatment utilization with the newly-eligible Medicaid population.

Suggested Citation

  • Maclean, J. Catherine & Saloner, Brendan, 2017. "The Effect of Public Insurance Expansions on Substance Use Disorder Treatment: Evidence from the Affordable Care Act," IZA Discussion Papers 10745, Institute of Labor Economics (IZA).
  • Handle: RePEc:iza:izadps:dp10745
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    3. Scott Barkowski & Joanne Song McLaughlin & Alex Ray, 2020. "A Reevaluation of the Effects of State and ACA Dependent Coverage Mandates on Health Insurance Coverage," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 39(3), pages 629-663, June.
    4. Johanna Catherine Maclean & Sebastian Tello-Trillo & Douglas Webber, 2019. "Losing insurance and behavioral health inpatient care: Evidence from a large-scale Medicaid disenrollment," NBER Working Papers 25936, National Bureau of Economic Research, Inc.
    5. Ramin Mojtabai & Christine Mauro & Melanie M Wall & Colleen L Barry & Mark Olfson, 2020. "Private health insurance coverage of drug use disorder treatment: 2005–2018," PLOS ONE, Public Library of Science, vol. 15(10), pages 1-11, October.
    6. Hamersma, Sarah & Maclean, Johanna Catherine, 2021. "Do expansions in adolescent access to public insurance affect the decisions of substance use disorder treatment providers?," Journal of Health Economics, Elsevier, vol. 76(C).
    7. Maclean, J. Catherine & Tello-Trillo, Sebastian & Webber, Douglas A., 2019. "Losing Insurance and Behavioral Health Hospitalizations: Evidence from a Large-Scale Medicaid Disenrollment," IZA Discussion Papers 12463, Institute of Labor Economics (IZA).
    8. Qiwei He & Scott Barkowski, 2020. "The effect of health insurance on crime: Evidence from the Affordable Care Act Medicaid expansion," Health Economics, John Wiley & Sons, Ltd., vol. 29(3), pages 261-277, March.
    9. Aparna Soni, 2020. "The effects of public health insurance on health behaviors: Evidence from the fifth year of Medicaid expansion," Health Economics, John Wiley & Sons, Ltd., vol. 29(12), pages 1586-1605, December.
    10. Mary A. Burke, 2019. "Access to medication-assisted treatment for opioid use disorder: is Rhode Island different, and why?," Current Policy Perspectives 19-2, Federal Reserve Bank of Boston.
    11. Lindsey Rose Bullinger & Sebastian Tello-Trillo, 2021. "Connecting Medicaid and child support: evidence from the TennCare disenrollment," Review of Economics of the Household, Springer, vol. 19(3), pages 785-812, September.
    12. Johanna Catherine Maclean & Michael F. Pesko & Steven C. Hill, 2017. "The Effect of Insurance Expansions on Smoking Cessation Medication Prescriptions: Evidence from ACA Medicaid Expansions," NBER Working Papers 23450, National Bureau of Economic Research, Inc.
    13. Mark McInerney, 2018. "Opioid Use Disorder Treatment and Mortality: Evidence from Variation in Services Offered," Working papers 2018-21, University of Connecticut, Department of Economics.
    14. Jacob Vogler, 2020. "Access to Healthcare and Criminal Behavior: Evidence from the ACA Medicaid Expansions," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 39(4), pages 1166-1213, September.
    15. David Slusky & Donna Ginther, 2017. "Did Medicaid Expansion Reduce Medical Divorce?," NBER Working Papers 23139, National Bureau of Economic Research, Inc.
    16. Lindsey Rose Bullinger, 2021. "Child Support and the Affordable Care Act's Medicaid Expansions," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 40(1), pages 42-77, December.
    17. Olga Scrivner & Thuy Nguyen & Kosali Simon & Esmé Middaugh & Bledi Taska & Katy Börner, 2020. "Job postings in the substance use disorder treatment related sector during the first five years of Medicaid expansion," PLOS ONE, Public Library of Science, vol. 15(1), pages 1-15, January.
    18. Sarah Hamersma & Johanna Catherine Maclean, 2018. "Insurance Expansions and Children’s Use of Substance Use Disorder Treatment," NBER Working Papers 24499, National Bureau of Economic Research, Inc.
    19. David Powell & Rosalie Liccardo Pacula, 2021. "The Evolving Consequences of OxyContin Reformulation on Drug Overdoses," American Journal of Health Economics, University of Chicago Press, vol. 7(1), pages 41-67.
    20. Johanna Catherine Maclean & Benjamin L. Cook & Nicholas Carson & Michael F. Pesko, 2017. "Public Insurance and Psychotropic Prescription Medications for Mental Illness," NBER Working Papers 23760, National Bureau of Economic Research, Inc.

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    More about this item

    Keywords

    healthcare; public insurance; Medicaid; substance use disorders;
    All these keywords.

    JEL classification:

    • I1 - Health, Education, and Welfare - - Health
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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