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The Affordable Care Act and Diabetes: Is There an Impact?

Increased access to healthcare can be beneficial to Medicaid recipients in expansion states…

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Medicaid coverage was expanded in January 2014 in twenty-six states and the District of Columbia via the adjustment of the program’s income requirement. Adults under the age of sixty-five whose income does not exceed 138% of the federal poverty level became eligible for Medicaid benefits. Because of Medicaid expansion, millions of uninsured adults gained access to healthcare. It was the perfect opportunity for researchers to investigate whether or not Medicaid expansion would have an impact on early detection and diagnosis of disease.

Diabetes diagnosis is the focus of this study, largely because it is such a common disease. More than twenty-eight million Americans are diabetic. Individuals newly diagnosed with diabetes were identified based on the assignment of a diabetes diagnosis code (250.x) or hemoglobin A1C levels greater than 6.4%. Data were collected from the Quest Diagnostics Database during the first six months of 2014, around the same time that the expansion started. These data were then compared to diagnosis rates from the previous year (2013). Individuals were further differentiated based on their healthcare coverage: Medicaid versus non-Medicaid enrollees.

During the first six months of both 2013 and 2014, 434,288 individuals were newly diagnosed with diabetes: 215,398 in 2013 and 218,890 in 2014. Overall, there was a 1.6% increase in the number of individuals who were newly diagnosed, regardless of state of residence or healthcare coverage. Medicaid enrolled individuals who were newly diagnosed (about 13% of the overall total) increased from 26,237 in 2013 to 29,673 in 2014; there was a 13% increase. More specifically, the number of newly diagnosed individuals who resided in expansion states (about 58% of the Medicaid enrolled individuals overall) increased by about 23%, while only increasing by about 0.4% in non-expansion states.

In states where more inclusive healthcare coverage exists for low-income adults because of the Affordable Care Act and Medicaid expansion, this study supports the idea that more individuals will be diagnosed and treated earlier. Early diagnosis and treatment could lead to better outcomes and a higher quality of life.

Practice Pearls:

  • Medicaid expansion has increased access to care for low-income adults, which has caused an increase in Medicaid-eligible, newly diagnosed diabetics.
  • Increased access to healthcare can improve outcomes and decrease long-term complications through early diagnosis and treatment.
  • There is potential for other common disease states to follow the same trend, including hypertension, hypercholesterolemia, and chronic kidney disease.

Kaufman HW, Chen Z, Fonseca VA, McPhaul MJ. “Surge in newly identified diabetes among Medicaid patients in 2014 within Medicaid expansion states under the Affordable Care Act.” Diabetes Care 38.5 (2015): 833-837. Web. 16 Jun 2015.