Effects of the ACA on Health Care Coverage for Adults With Substance Use Disorders

Mark Olfson, Melanie M. Wall, Colleen L. Barry, Christine Mauro, C. Jean Choi, Ramin Mojtabai

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVE: The authors assessed changes in health care coverage in nationally representative samples of low- and middle-income adults with and without substance use disorders following the 2014 Affordable Care Act marketplace launch and Medicaid expansion. METHODS: Data from the 2012-2018 (N=407,985) National Survey on Drug Use and Health identified low- and middle-income nonelderly adults with alcohol, marijuana, cocaine, or heroin use disorders. A sociodemographically adjusted difference-in-differences analysis assessed the trends in Medicaid and individually purchased private insurance between adults with and without substance use disorders. RESULTS: Between 2012-2013 and 2015-2016, the percentages without health insurance significantly declined for adults with substance use disorders (from 27.8% to 18.7%) and for those without these disorders (from 22.6% to 14.6%). These trends were related to gains in Medicaid and in individually purchased private insurance but not to gains in employer-based private insurance coverage. Between 2015-2016 and 2017-2018, however, the percentages without health insurance among adults with substance use disorders (18.7% to 18.4%) and without these disorders (14.7% to 14.7%) was little changed. CONCLUSIONS: With insurance gains having stalled and the downturn of the U.S. economy, there is renewed urgency to extend health care coverage to middle- and low-income adults with substance use disorders that meets their substance use and general health needs.

Original languageEnglish (US)
Pages (from-to)905-911
Number of pages7
JournalPsychiatric services (Washington, D.C.)
Volume72
Issue number8
DOIs
StatePublished - Aug 1 2021
Externally publishedYes

Keywords

  • Alcohol and drug abuse
  • Health care reform

ASJC Scopus subject areas

  • Psychiatry and Mental health

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