"Health Insurance and Opioid Deaths: Evidence from the Affordable Care Act Young Adult Provision," by Gal Wettstein. Forthcoming in Health Economics.
Accidental drug overdoses have become the leading cause of death for those under age 50, and the rate of death via opioids has increased dramatically in the last few years. In 2017, approximately 72,000 people died of a drug overdose in the United States, which is nearly twice as many as in 2013 and four times as many as at the turn of the 21st century.
The recent spike in drug mortality coincides with the advent of the Affordable Care Act, which greatly increased the ability of young people to obtain medical coverage. In the years following the ACA's passage, insurance coverage for people between 18 and 25 increased from 70% to 87%. This has led some people to infer that the increase in insurance coverage contributed to the increase in opioid deaths. The rationale is that having a doctor and insurance coverage makes it easier for people to access and become addicted to opioids, despite attempts in recent years to restrict the availability of the drugs.
Despite the timing, it is not clear that the increase in opioid deaths has anything to do with the increase in health insurance coverage. In this paper, Gal Wettstein notes that, ex ante, the very opposite effect is possible: People with regular health care should have better health and thus have less reason to seek painkillers to begin with. Moreover, those who do become addicted will find it easier to access treatment via mental health counseling or medication, as well as follow-up care. Most importantly, addicts with insurance generally abuse prescription opioids, which are less risky than heroin or other narcotics bought illegally. Indeed, the Centers for Disease Control attributes fully 40% of all overdose deaths to fentanyl, an incredibly lethal drug that is often added to batches of heroin to accentuate the high it confers.
With such confounding intuitions, Wettstein turns to the data to attempt to determine if there is a connection between the ACA and opioid deaths. He uses the ACA's health insurance provision for young adults as a quasi-experiment. The ACA allows children to remain on their parents' health insurance until they turn 26, and this provision took effect upon the law's passage on September 23rd, 2010, while many other ACA provisions did not take effect until 2014. The distinct implementation dates mean that we should see...