Trends in insurance coverage and treatment among persons with opioid use disorders following the Affordable Care Act

- The United States (US) is in the midst of an epidemic of opioid overdose deaths.
- The Affordable Care Act (ACA) expanded Medicaid to low-income childless adults formerly ineligible for insurance.
- After the ACA, rates of uninsured persons with heroin disorders fell.
- Among persons with heroin disorders in treatment, payment by insurance increased.
- There was no change in the overall rate of treatment.

PurposeThis short communication examines the impact of the Patient Protection and Affordable Care Act (PPACA) on insurance coverage and substance use treatment access among persons with opioid use disorders.MethodsData came from the 2010-2015 National Surveys on Drug Use and Health. Among persons with heroin and opioid pain-reliever use disorders, measures of insurance coverage and treatment access were compared before and after the implementation of major PPACA provisions that expanded access to insurance in 2014.ResultsThe prevalence of uninsured persons among those with heroin use disorders declined dramatically following PPACA implementation (OR 0.59, 95% CI 0.39-0.89), largely due to an increase in the prevalence of Medicaid coverage (OR 1.96, 95% CI 1.21-3.18). There was no evidence of an increase in the prevalence of treatment, but among persons who received treatment, there was an increase in the proportion whose treatment was paid for by insurance (OR 3.75, 95% CI 2.13-3.18). By contrast, there was no evidence the uninsured rate declined among persons with pain-reliever use disorders.ConclusionsThe PPACA Medicaid expansion increased insurance coverage among persons with heroin use disorders, and likely plays an essential role in protecting the health and financial security of this high-risk group. More research is needed on the relationship between insurance acquisition and utilization of substance use treatment.