Changes in health insurance and payment for substance use treatment.

Based on data from the National Household Survey on Drug Abuse in 1994 (N = 10, 158) and 1998 (N = 12,892) alcohol- or drug-using subsamples (aged 18-64) were compared to see if postwelfarereform reports of having employer-paid health insurance increased and Medicaid decreased by 1998 and affected participation in substance use treatment. By 1998, respondents were more likely to report having employer-paid insurance but reported source of payment for substance use treatment did not differ by year. In 1998, privately insured respondents were less likely to know if they had coverage for substance use treatment than in 1994. Of privately insured in treatment, 24% did not know if insurance covered treatment; most of these said they paid for treatment out-of-pocket. Despite reported increases in employer-paid insurance, uncertainty about its coverage of substance use treatment also increased and was associated with reports of not using it to pay for treatment.