Short term effects of the Affordable Care Act on drug overdoses in the United States

The objective of this study is to ascertain whether the Affordable Care Act (ACA) coverage has had a significant short-term effect on opioid overdose deaths. Opioid abuse has become a major public health crisis in the United States, with overdose deaths increasing 50% in recent (2012-15) years. One factor that might have contributed to the crisis is the ACA’s expansion of insurance coverage which started in 2014. Better coverage, on the one hand, could have led to more opioid-related deaths by providing increased access to medical treatments that provided pain management utilizing opioids. On the other hand, increased coverage might have had a salutary effect on drug overdoses by providing greater access to drug addiction treatment and counseling as well as to drugs that prevent accidental overdose deaths (e.g., naloxone). County-level data for the four year period immediately before and after ACA adoption (2012-2015) were assembled. Drug overdose data from the Center for Disease Control (CDC) was the dependent variable, while changes in the percentage insured in each county were included as the explanatory variable to measure the impact of the ACA. Other explainers included population density, median income, unemployment, ethnic makeup, the number of veterans and college graduation rates, as well as two measures of county health care supply (i.e., the number of hospital beds and active physicians per capita). Sources for the explanatory variables included the Census Bureau’s American Community Survey and the Health Resources & Services Administration Area Resources Health Resources file. Data for the balanced panel of 3001 (of 3143) counties in the U.S. was analyzed using a fixed effects regression model compensating for cross-sectional dependence using panel corrected standard errors. Preliminary analysis demonstrates that changes in population density, unemployment and insurance coverage have had significant effects on drug overdoses, but the effect of insurance depends on the age of the newly insured. Increased insurance coverage of younger (19 to 39) adults led to more accidental overdoses, whereas greater coverage for those older (40 to 64) led to fewer deaths. Areas with declining populations and greater unemployment also experienced more overdoses. None of the other sociodemographic or medical supply variables evidenced significant effects.