THE IMPACT OF STATE HEALTH INSURANCE PARITY LAWS ON INITIATION OF SUBSTANCE USE DISORDER TREATMENT
Kealhofer, Marc A.
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Statement of Problem: The implementation of the Patient Protection and Affordable Care Act (PPACA) of 2010 is expected to change the Substance Use Disorder (SUD) treatment system drastically through its expansion of federal parity protections on mental health and SUD benefits. However, the impact of previously existent state-specific parity laws on access to and use of SUD treatment has not been fully explored. In this study, we aim to compare initiation of substance use treatment between individuals in states with and without SUD parity laws in the year 2001, using longitudinal data from two waves of the National Epidemiologic Survey on Alcohol and Related Conditions that took place respectively in 2001-2002 and 2004-2005. Methods: Stabilized inverse probability of treatment weights were used in conjunction with survey weights to adjust for potential confounders. Logistic regression models were then used to compare odds of treatment initiation among individuals reporting past year substance use (but no past year substance use treatment) in states with SUD parity laws compared to states with no laws. Sub-analyses were performed to focus on individuals with lifetime history of SUD as well as to analyze separately alcohol users and other substance users. Results: Individuals reporting past year substance use at baseline in parity states had a 1.55 higher odds of treatment initiation than those in states without SUD parity (95% CI: 0.63-3.81). Individuals with lifetime history of SUD at baseline in parity states and current substance use had a 1.69 higher odds of treatment initiation than those in states without SUD parity (95% CI: 0.81-3.54). Individuals with lifetime history of AUD (no other SUDs) at baseline in parity states and current substance use had a 4.61 higher odds of treatment initiation than those in states without SUD parity (95% CI: 1.27-16.77). Conclusions: Parity was only associated with significantly higher odds of SUD treatment initiation among those with lifetime history of AUD and current substance use. Advisor: Rosa Crum, MHA, MD Reader: Ramin Mojtabai, PhD, MPH, MD