Impact of health reform on health insurance status among persons who use opioids in eastern Kentucky: A prospective cohort analysis

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2 Scopus citations


Background: Health insurance improves health and reduces mortality. Expanding insurance is a central feature of the Affordable Care Act (ACA). Persons who use drugs (PWUDs) have historically been at high risk of being uninsured. It is unknown if Appalachian PWUDs, who live in an extremely economically distressed region, are more likely to be insured since implementation of the ACA. Methods: Data from a cohort of 503 PWUDs from eastern Appalachian Kentucky, who were interviewed at seven time-points between 2008 and 2017, were analysed using mixed effects regression models. Results: At baseline, only 33.8% of participants were insured, which increased to 87.3% of the cohort at the last follow-up interview. The final multivariate model, which included baseline characteristics and interactions by time, indicated there were significant baseline differences in insurance status by gender, age, education, income, and history of injection. Differences in the predictive margin probabilities of being insured across these groups had dissipated by the final follow-up interview. Conclusions: After Kentucky's implementation of the ACA, this cohort of Appalachian PWUDs made substantial gains in obtaining insurance that far exceeded the increases reported in national studies.

Original languageEnglish
Pages (from-to)8-14
Number of pages7
JournalInternational Journal of Drug Policy
StatePublished - Aug 2019

Bibliographical note

Funding Information:
This research was supported by grants from the National Institute on Drug Abuse ( R01DA033862 and R01DA024598 ). NIDA had no further role in study design; in the collection, analysis, or interpretation of data; or the preparation of this manuscript. The authors are solely responsible for this content, and this manuscript does not represent the official views of the NIH or NIDA.

Funding Information:
Hannah Knudsen and Jennifer Havens have no conflicts of interest to declare. In recent years, Michelle Lofwall has received contract funding to support research from Braeburn Pharmaceuticals (which has developed a buprenorphine product), has provided consultation to Braeburn, CVS Caremark, and Indivior (which manufacture buprenorphine products), and has received honoraria from PCM Scientific, which received unrestricted educational grant funds from Reckitt Benckiser (now Indivior), for work in developing and presenting educational talks on opioid use disorder. Sharon Walsh has received consulting fees and research support from Braeburn Pharmaceuticals, consulting fees from Camurus, honoraria and travel support from Indivior, and honoraria from PCM Scientific, through an unrestricted educational grant from Reckitt Benckiser, for serving as a speaker and conference organizer.

Publisher Copyright:
© 2019 Elsevier B.V.


  • Affordable Care Act
  • Appalachia
  • Health insurance
  • Persons who use drugs

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Health Policy


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