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The misuse of prescription opioids has become a serious epidemic in the United States. In response, states have implemented Prescription Drug Monitoring Programs (PDMPs), which record a patient’s opioid prescribing history. While few providers participated in early systems, states have recently begun to require providers to access the PDMP under certain circumstances. We find that “must access” PDMPs significantly reduce measures of misuse in Medicare Part D. In contrast, we find that PDMPs without such provisions have no effect. We find stronger effects when providers are required to access the PDMP under broad circumstances, not only when they are suspicious.

Large disparities in health insurance coverage and access to health services have long persisted in the US health care system. We considered how the insurance coverage expansions of the Affordable care Act have affected disparities related to race and ethnicity. In the years since the law went into effect, insurance coverage has increased significantly for all racial/ethnic groups. Because coverage increased more for non-Hispanic blacks and Hispanics than for non-Hispanic whites, disparities in coverage have decreased. Despite these improvements, a large number of adults remain uninsured, and the uninsurance rate among blacks and Hispanics is substantially higher than the rate among whites.

Objectives. To document how health insurance coverage changed for White, Black, and Hispanic adults after the Affordable Care Act (ACA) went into effect. Methods. We used data from the American Community Survey from 2008 to 2014 to examine changes in the percentage of nonelderly adults who were uninsured, covered by Medicaid, or covered by private health insurance. In addition to presenting overall trends by race/ethnicity, we stratified the analysis by income group and state Medicaid expansion status. Results. In 2013, 40.5% of Hispanics and 25.8% of Blacks were uninsured, compared with 14.8% of Whites. We found a larger gap in private insurance, which was partially offset by higher rates of public coverage among Blacks and Hispanics. After the main ACA provisions went into effect in 2014, coverage disparities declined slightly as the percentage of adults who were uninsured decreased by 7.1 percentage points for Hispanics, 5.1 percentage points for Blacks, and 3 percentage points for Whites. Coverage gains were greater in states that expanded Medicaid programs. Conclusions. The ACA has reduced racial/ethnic disparities in coverage, although substantial disparities remain. Further increases in coverage will require Medicaid expansion by more states and improved program take-up in states that have already done so.

Historically, lesbian, gay, bisexual, and transgender (LGBT) adults have faced barriers to obtaining health insurance coverage, which have contributed to disparities in access to care and health outcomes. The Affordable Care Act (ACA) and the 2015 Supreme Court ruling on marriage equality had the potential to improve access to health insurance for LGBT people. Using data from the nationally representative Health Reform Monitoring Survey, we provide new evidence on trends in coverage and access to care for LGBT and non-LGBT adults between 2013 and 2019. In 2013 LGBT adults were significantly less likely than non-LGBT adults to have insurance coverage and more likely to report difficulty obtaining necessary medical care. Disparities in insurance coverage began to decline in 2014, when the main coverage provisions of the ACA went into effect. By 2017-19, coverage rates for LGBT adults were comparable to those of non-LGBT adults, although significant disparities in access remained.

With the expiration of the Medicaid continuous coverage condition on March 31, 2023, states began returning to regular eligibility renewals in Medicaid and the Children's Health Insurance Program (CHIP). Because of incompleteness of administrative data and lags in the availability of survey data, there is limited understanding of how this \"unwinding\" process has affected insurance coverage or access to care. Using data from IQVIA PayerTrak, a large, nationally representative, all-payer pharmacy transactions database, we examined the trends in prescription drug use during the unwinding period. Leveraging state variation in Medicaid coverage termination start dates, we found that although prescriptions paid for by Medicaid or CHIP fell during unwinding, this decline was mostly offset by an increase in commercial-paid prescriptions. Total prescriptions were unchanged, suggesting that the unwinding did not result in reduced access to medications.

Forty states mandate that providers query their patients' prescription histories in the state's prescription drug monitoring program (PDMP) before prescribing controlled substances. However, little is known about providers' use of PDMPs, either with or without a mandate. We measured the share of opioid prescriptions with PDMP queries in Kentucky from 2010 to 2018, before and after the implementation of the first comprehensive PDMP mandate in the Us. Providers queried the PDMP for 12 percent of opioid prescriptions before the mandate; after the mandate, they queried for 56 percent of prescriptions. The share of prescriptions queried was lowest for patients without recent opioid use (3 percent before the mandate, 25 percent after) and highest for pain management specialists (31 percent before, 72 percent after). Over time, high-compliance providers reduced prescribing to the riskiest patients, whereas low-compliance providers continued to prescribe to them. Although the share of prescriptions queried greatly increased after the mandate, compliance remained incomplete, including for patients with high-risk patterns of opioid use.

In 2020, Colorado became the first state to cap out-of-pocket spending for insulin prescriptions, requiring fully insured health plans to cap out-of-pocket spending at $100 for a thirty-day supply. We provide the first evidence on the association of Colorado's Insulin Affordability Program with patient out-of-pocket spending, the amounts paid by plans per insulin prescription, and prescription filling. Using statewide claims data from the period 2018-21, we focused on the first two years that the copay cap law was in effect. We found that Colorado's Insulin Affordability Program was associated with significant reductions in out-of-pocket spending for insulin prescriptions, with the mean out-of-pocket payment per thirty-day supply falling nearly in half (from $62.59 to $35.64). Average plan payments increased slightly more ($31.39) than the decrease in out-of-pocket spending, as the total amount paid per prescription increased by about 1 percent. The average insulin user realized annual savings of $184, while the mean number of fills and the mean days' supply per year increased by 4.2 percent and 11.4 percent, respectively.

We examined the complex relationship among work, health, and health insurance, which has been affected by changing demographics and employment conditions in the United States. Stagnation or deterioration in employment conditions and wages for much of the workforce has been accompanied by the erosion of health outcomes and employer-sponsored insurance coverage. In this article we present data and discuss the research that has established these links, and we assess the potential impact of policy responses to the evolving landscape of work and health. The expansion of insurance availability under the Affordable Care Act may have helped reduce the burden on employers to provide health insurance. However, the act's encouragement of wellness programs has uncertain potential to help contain the rising costs of employer-sponsored health benefits.

We examine the effects of the most durable employer health insurance mandate in the United States, Hawaii's Prepaid Health Care Act, using Current Population Survey data covering the years 1979 to 2005. Relying on a variation of the classical Fisher permutation test applied across states, we find that Hawaii's law increased insurance coverage over time for worker groups with low rates of coverage in the voluntary market. We find no statistically significant support for the hypothesis that the mandate reduced wages and employment probabilities. Instead, its primary detectable effect was an increased reliance on exempt part-time workers.