The Impact of the Affordable Care Act Insurance Expansions on Opioid-Related Emergency Department Visits

Published in: American Journal of Health Economics (2022). doi: 10.1086/722928

Posted on RAND.org on October 27, 2022

by Sandra L. Decker, Michael Dworsky, Teresa B. Gibson, Rachel M. Henke, Kimberly Walsh McDermott

Read More

Access further information on this document at The University of Chicago Press

This article was published outside of RAND. The full text of the article can be found at the link above.

Amid rising opioid-related deaths and hospital use, the 2010 Patient Protection and Affordable Care Act (ACA) was signed into law, with the central coverage provisions implemented in 2014. We leverage these ACA coverage expansions (including Medicaid expansion and Marketplaces) to study the impact of health insurance on opioid-related emergency department (ED) visits while accounting for potentially confounding changes in relevant state-level policies. In difference-in-difference-in-differences (DDD) models that compared low- and high-uninsurance areas within states, we found evidence of a dose-response relationship between pre-ACA uninsurance and changes in ED visit rates in both expansion and nonexpansion states: Areas with higher uninsurance rates prior to the ACA saw larger reductions in opioid-related ED visits after the ACA took effect. Effects were also time-varying, with no significant dose-response relationship emerging until the third year of ACA implementation. These estimates suggest that increasing insurance coverage among the uninsured may help mitigate harms of the opioid crisis.

Research conducted by

This report is part of the RAND Corporation External publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.