It’s hard to say exactly what’s happening here. The divergence in deaths between Medicaid and non-Medicaid counties started in 2010, and the full expansion went into effect in 2014, so it can’t be just that Medicaid has made it easier for addicts to get painkillers. (The Spotted Toad analysis speculates that an Obamacare provision that was implemented earlier, allowing twentysomethings to stay on their parents’ health insurance plans, may also have made opioid prescriptions easier to obtain.)
But whatever is driving this trend, it’s a reminder that insurance coverage does not guarantee public health improvement. And so is a new paper, just released through the National Bureau of Economic Research, that tries to look at the Affordable Care Act in full. Its authors find, as you would expect, a substantial increase in insurance coverage across the country. What they don’t find is a clear relationship between that expansion and, again, public health. The paper shows no change in unhealthy behaviors (in terms of obesity, drinking and smoking) under Obamacare, and no statistically significant improvement in self-reported health since the law went into effect. (There is some improvement for older Americans in Medicaid expansion states, but not for the population as a whole.)
Add these data points together and you end up with some (highly provisional) vindication for what conservatives and libertarians argued before the A.C.A. was passed: that the bill was likely to provide its beneficiaries with more financial security and greater peace of mind, but that it was not likely to be the sweeping lifesaver that many of its most morally imperious advocates insisted that it would be.