01 Apr ACA Medicaid Expansion Linked to Fewer Opioid Hospitalizations, but not ER Visits
MedicalResearch.com Interview with:
Aparna Soni PhD, Assistant Professor
Department of Public Administration and Policy
School of Public Affairs
American University Washington, DC
MedicalResearch.com: What is the background for this study?
Response: The United States is in the midst of an opioid epidemic. Opioids are responsible for nearly 50,000 deaths per year and present a substantial financial burden on hospitals. The rate of opioids-related hospital events has tripled since 2005.
We are particularly concerned about rising hospitalizations because they may stem from a lack of access to treatment for individuals with opioid use disorder. Medication-assisted treatment is effective in treating opioid use disorder but can be unaffordable for people without health insurance.
MedicalResearch.com: What are the main findings?
Response: Our goal was to understand how the Affordable Care Act Medicaid expansion – which expanded Medicaid eligibility to all low-income people with household income less than 138% of the poverty level in the states that chose to participate – affected rates of opioid-related hospital events. We compared changes in hospital events in states that expanded Medicaid versus those that did not expand, before and after the expansion.
We found that the ACA Medicaid expansions were associated with a 9.7% reduction in the rate of opioid-related inpatient hospitalizations. We did not find a significant association between Medicaid expansion and opioid-related emergency department visits.
MedicalResearch.com: What should readers take away from your report?
Response: Expanding Medicaid may be an effective way to reduce opioid-related hospitalizations. A host of previous studies have found that Medicaid expansion increased access to outpatient treatment for opioid use disorder, and our results suggest that this increased treatment access may have had a trickle-down effect on reducing opioid-related hospitalizations.
In addition to reducing opioid-related hospitalizations overall, the Medicaid expansion shifted the payment source for hospitalizations that did happen from self-pay and charity care to Medicaid. This suggests that Medicaid expansion is a financial benefit for both newly-insured patients and hospitals.
Another interesting finding was that opioid-related hospitalizations decreased more in states with greater treatment capacity. Specifically, states that had a larger number of physicians authorized to prescribe buprenorphine (a treatment medication for opioid use disorder) experienced greater reductions in opioid-related hospitalizations after Medicaid expansion.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Our data were at the state level, so we could not isolate the population that might be most affected by the ACA Medicaid expansions (i.e. low-income childless adults). Future studies should use patient-level hospitalizations data to understand how the expansions affected hospital use among subpopulations most likely to be impacted by the Medicaid expansions. It would also be interesting to study whether the severity of emergency department visits and hospital admissions changed as a result of the Medicaid expansion. Future research can also link hospital records to outpatient treatment settings to understand whether patients received outpatient treatment for opioid-use disorder before or after hospital visits.
Wen H, Soni A, Hollingsworth A, et al. Association Between Medicaid Expansion and Rates of Opioid-Related Hospital Use. JAMA Intern Med. Published online March 23, 2020. doi:10.1001/jamainternmed.2020.0473
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