ACA may have helped mitigate opioid epidemic
The Medicaid expansion under the Affordable Care Act was linked to a reduction in opioid overdose deaths, study findings in JAMA Network Open show.
However, separate findings also published in JAMA Network Open revealed that opioid or other drug addiction or abuse remains a particularly “serious problem” in rural communities in the United States. In addition, one in three adults living in these areas continue to struggle paying medical bills, even after the implementation of the ACA.
“More than half of rural U.S. adults identified a need for outside help to solve major local problems, including seeing a major role for government specifically,” Mary G. Findling, PhD, ScM, research associate of the department of health policy and management at the Harvard T.H. Chan School of Public Health, and colleagues wrote.
‘Empirical support’ for expanding Medicaid
In the first study, Nicole Kravitz-Wirtz, PhD, MPH, professional researcher at the department of emergency medicine at the University of California Davis School of Medicine, and colleagues gathered opioid overdose data from 3,109 counties in 49 states and Washington, D.C., from Jan. 1, 2001, to Dec. 31, 2017.
Researchers identified 383,091 opioid overdose fatalities across these counties during the study period, with a mean of 7.25 deaths per county. States that adopted the Medicaid expansion under the ACA had a 6% lower rate of total opioid overdose deaths compared with states that did not expand Medicaid (RR = 0.94; 95% credible interval, 0.91-0.98).
In addition, counties in expansion states had an 11% lower death rate involving heroin (RR = 0.89; 95% credible interval, 0.84-0.94) and a 10% lower death rate involving synthetic opioids other than methadone (RR = 0.9; 95% credible interval 0.84-0.96) vs. counties in nonexpansion states. However, researchers observed an 11% increase in methadone-related overdose mortality in expansion states (RR = 1.11; 95% credible interval 1.04-1.19). An association between Medicaid expansion and deaths involving semisynthetic opioids and natural opioids “was not well supported” (RR = 1.03; 95% credible interval, 0.98-1.08), according to the researchers.
“We found empirical support for adopting and sustaining health coverage expansions as a potential tool for reducing opioid overdose deaths in the United States,” Kravitz-Wirtz and colleagues wrote, encouraging states to incorporate these findings into conversations addressing the opioid epidemic. “In particular, given 82,228 opioid-related deaths from 2015 to 2017 in the 32 states that expanded Medicaid between 2014 and 2016, our findings suggest that these states would have had between 83,906 and 90,360 deaths in the absence of the expansion, implying that Medicaid expansion may have prevented between 1,678 and 8,132 deaths in these states during those years.”
‘Serious problem’ in rural America
In the second study, Findling and colleagues reviewed two polls conducted in rural America — one in 2018 and one in 2019 — with a total of 2,708 respondents. Among both polls, 78% of respondents were non-Hispanic white and more than 50% of participants were aged 50 years and older.
Researchers found that 25% (95% CI, 22-28) of respondents identified opioid or other drug addiction or abuse as “the most urgent health-specific problem” facing their local communities, while 21% (95% CI, 19-24) said that the economy was the most serious concern.
Additional data showed that 57% (95% CI, 53-60) of respondents viewed opioid or other drug addiction or abuse as a “serious problem” in their local community and 49% (95% CI, 46-53) said they personally know someone who has had opioid addiction. Meanwhile, 32% (95% CI, 29-36) of respondents reported problems with paying medical bills, and 26% (95% CI, 23-30) said that they had issues accessing health care. Nearly half of respondents also said they would have problems paying off an unanticipated $1,000 expense.
Researchers noted that the survey respondents’ concerns about opioid use being a “major threat” in the communities in which they lived mirrored previous findings, suggesting that “there is wide public support for redirecting policy makers’ attention and funds toward handling the opioid epidemic in rural areas.” – by Janel Miller
Disclosures: Findling and Kravitz-Wertz report no relevant financial disclosures. Please see the studies for all other authors’ relevant financial disclosures.