PILLS, POLICY, PROVIDERS: ANALYZING THE IMPACTS OF STATE-LEVEL ACA MEDICAID EXPANSIONS ON COUNTY-LEVEL OPIOID PRESCRIBING RATES

Abstract

State Medicaid expansions under the Affordable Care Act have attracted controversy for their purported role in worsening the nation's opioid epidemic. There is a perception in some political spheres that the expansions have increased the risk for more people to become addicted by increasing access to prescription opioids or have created significant opportunities to abuse and profit from the Medicaid system by flooding illegal drug markets with legally obtained prescription opioids. On the other hand, advocates of Medicaid point to the fact that the program provides beneficiaries with access to essential health services, including medication-assisted treatments that aid in treating opioid addiction, as evidence that the Medicaid expansions are actually helping to stem the flow of opioid-related deaths. This study employs a quasi-experimental difference-in-difference technique to study the impact of six state-level Medicaid expansions on country-level opioid prescribing rates, exploiting variation variation in expansion status across state borders. This thesis contributes evidence the state-level ACA Medicaid expansions in January of 2014 did not significantly increase opioid prescribing rates on the county level. This reduces worries that Medicaid expansion would further contribute to the opioid epidemic by increasing access to addictive gateway prescription drugs. Policymakers desiring to reduce opioid addiction by helping at-risk patients receive medication-assisted treatment should consider expanding Medicaid in their states, as well as substantially increasing funding for the program.