Recognizing that excessive drinking is a leading cause of preventable death in the US and that US opioid mortality rates have risen dramatically in recent decades, the US Affordable Care Act and Medicaid expansion sought to increase Americans’ health insurance coverage and access to substance use treatment services. Whether or not these landmark policies benefitted diverse population subgroups is an important public health question. A study, led by Senior Scientist Nina Mulia, examined the impact of Medicaid expansion on alcohol and opioid treatment admission rates in the overall adult population, and across racial and ethnic groups, including Black, Hispanic/Latinx, and White Americans.
The study highlights the impact that Medicaid expansion has had in increasing access to substance use treatment for many low-income and racial and ethnic minority groups. Our research showed that expansion led to increased, Medicaid-insured alcohol and opioid treatment rates in the general population, and particularly among Black and Hispanic/Latinx groups.
While the increased rates of treatment entry are promising, the study’s findings also suggest that there are significant disparities emerging between low-income individuals living in expansion and non-expansion states. The majority of states which have not expanded Medicaid eligibility are located in the southern region of the U.S.. These gaps in coverage are also notable because Black Americans disproportionately live in the US south compared to other parts of the U.S., which has implications for furthering inequities in access to treatment and other crucial health care among these communities.
Alcohol and opioid treatment entry rates were decreasing or flat during the period examined by our study from 2010 through 2016. Our finding that Medicaid expansion was associated with rising Medicaid-insured treatment admission rates after the policy went into effect is all the more notable.
Funding for the study was supported by the National Institute on Alcohol Abuse and Alcoholism at the National Institutes of Health under the award P50AA005595 (PI: Kerr; Project Lead: Mulia).
Mulia, N., Lui, C.K., Bensley, K.M.K, Subbaraman, M.S. (2022). Effects of Medicaid expansion on alcohol and opioid treatment admissions in U.S. racial/ethnic groups, Drug and Alcohol Dependence, 231. doi.org/10.1016/j.drugalcdep.2021.109242