Did the ACA Medicaid Expansions Fuel the Opioid Epidemic?

Abstract

The Medicaid expansions made addiction treatment more accessible but they also made it easier to obtain the prescription opioids that can trigger an addiction. We investigated the association between the Medicaid expansions and drug-related mortalities. Number of studies have investigated this question and found conflicting results. We add to the literature by explicitly accounting for the properties of illicit drug markets, and by conducting a simulation based power analysis to assess whether a plausible change in drug-related mortality in expansion states could be detected with our data. We found inconclusive results. We argue that there are three main challenges in identifying the effect of the Medicaid expansions on drug-related mortality that cannot be sufficiently addressed with the current data: (i) non-parallel pre-expansion trends in drug-related mortality; (ii) the contemporaneous surge in the supply of illicitly manufactured fentanyl, and (iii) lack of statistical power. We argue that more comprehensive data is needed to answer this question.