Medicaid and mortality

| Gabriel |

This morning Spotted Toad picked up on the point in Quinones that a lot of pill mills were funded through Medicaid fraud and so he used Medicaid expansion under Obamacare to see if this led to greater drug overdoses in Medicaid expansion states. In fact he found that in the time since the Medicaid expansion, states that participated in the expansion had faster growth in overdose deaths than states that refused Medicaid expansion. That’s interesting, but I never want to base a trend on just two time points. (FWIW, Toad was analyzing the data as the CDC presents it — the analysis below requires a lot more queries). So I queried the CDC data in more granular detail to check if the trend started with Medicaid expansion. (saved query link, just iterate over year to get annual state-level OD deaths).

As it turns out, I was able to replicate Toad’s finding that Medicaid expansion states (blue) have higher rates and faster growth in fatal drug overdoses than Medicaid holdout states (red), but the two groups of states diverged starting in 2010, well before states began implementing Obamacare’s Medicaid expansion. So there may be a real difference between Medicaid expansion states (which are generally Democratic) and Medicaid holdout states (which are Republican), and the difference may even be some aspect of health policy, but it wasn’t Obamacare Medicaid expansion as the divergence starts too early. (It’s worth noting that Toad updated his own post with my graph as soon as I sent it to him).

Here is the data in Stata format (which you can reconstruct yourself from a series of CDC queries).

Here is the code

cd "~/Documents/codeandculture/cdcdrugmortality"
*https://wonder.cdc.gov/controller/saved/D76/D11F702


clear
gen state=""
gen year=.
save drugs19992015.dta, replace

forvalues i=1999/2015 {
 disp "`i'"
 insheet using drugs`i'.txt, clear
 append using drugs19992015.dta, force
 recode year .=`i'
 save drugs19992015, replace
}
drop if state==""

desc
sum

insheet using medicaidholdouts.txt, clear
ren v1 state
save medicaidholdouts.dta, replace

use medicaidholdouts, clear
merge 1:m state using drugs19992015
ren _merge medicaidexpansion 
recode medicaidexpansion 2=1 3=0

list state medicaidexpansion if (state=="Texas" | state=="California") & year==2010

save drugs19992015, replace

collapse (sum)deaths population, by (year medicaidexpansion)
gen cruderate= deaths/population
twoway (line cruderate year if medicaidexpansion==1) (line cruderate year if medicaidexpansion==0) , legend(order(1 "Medicaid expansion" 2 "Holdouts")) ytitle(Weighted Crude Rate of Fatal Drug Overdoses)
graph export medicaidod.png, replace

*have a nice day

And here’s my list of Medicaid holdouts:

Alabama
Florida
Georgia
Idaho
Kansas
Mississippi
Missouri
Nebraska
North Carolina
Oklahoma
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Wisconsin
Wyoming