Association for Public Policy Analysis & Management

The concurrence of health insurance expansion under the Affordable Care Act (ACA) and increasing opioid-related mortality has led to debate whether insurance increases or decreases opioid deaths. I apply two empirical approaches to address the question using the introduction of the ACA young adult provision as a quasi-experiment. I use the resulting policy-induced variation across states over time in access to health insurance among young adults to study its effect on opioid-related mortality. The first approach is a difference-in-differences using those too old to benefit from the young adult provision as a control group; the second uses the share of state populations which stood to gain insurance before the ACA to perform a dose-response analysis. I find that the young adult provision reduced opioid-related mortality. The analysis suggests that 1 percentage point more coverage reduced opioid mortality among young adults by 3.6/100,000, or 16.5 percent.