Medicaid expansion under the Patient Protection and Affordable Care Act (ACA) was associated with reduced uninsured rates in the diabetes belt compared with non-belt counties, say researchers writing in Diabetes Care.
The diabetes belt, a region across 15 southern and eastern states in which residents have high rates of diabetes, is an important region for public health interventions to reduce health disparities. This area is populated by more non-Hispanic African Americans than the rest of the country, and its population has a higher prevalence of obesity and sedentary lifestyle. Access to care and lack of health insurance coverage have been identified as the main reasons for health disparities in the region. While data has shown that insurance coverage increased with the Medicaid expansion, under the ACA, in people aged 65 years or younger with diabetes, there are still no data on how the expansion has affected insurance coverage for low income adults in the same age group who live in the diabetes belt.
In this study, researchers examined trends in uninsured rates between 2012 and 2016 among low-income adults aged 65 years or younger to determine whether the ACA’s expansion of Medicaid impacted insurance coverage in the diabetes belt. Data for 3,129 counties were used to analyze trends in uninsured rates among populations with a household income at least 138 percent below the federal poverty level.
In 2012, 39 percent of the population in the diabetes belt and 34 percent in non-Belt counties were uninsured (P < 0.001). In 2016 in states where Medicaid was expanded, uninsured rates fell to 13 percent and 15 percent, respectively. Adjusting for county demographic and economic factors, Medicaid expansion helped reduce uninsured rates by 12.3 percent in diabetes belt counties and by 4.9 percent in non-belt counties. Meanwhile, in 2016, uninsured rates were 15 percent higher for both diabetes belt and non-belt counties in the non-expansion states than in the expansion states.
“Initial disparities in uninsured rates between diabetes belt and non-belt counties have not existed since 2014 among expansion states,” wrote the authors, led by Min-Woong Sohn, Ph.D., of the University of Virginia in Charlottesville.
“Previous studies have shown that increased access to healthcare is generally associated with improved diagnosis and treatment of diabetes, greater adherence to medication regimens, fewer emergency room visits, and more outpatient visits,” the authors wrote. “Greater access to care also seems to improve medication use for diabetes, hypertension, and hyperlipidemia and leads to improved laboratory test results and blood pressure readings.”
However, the authors recommended that further research is needed to examine whether and how Medicaid expansion may have contributed to an increase in the use of health services in order to prevent and treat diabetes in the diabetes belt.
Jennifer M. Lobo, Soyoun Kim, Hyojung Kang, et al. “Trends in Uninsured Rates Before and After Medicaid Expansion in Counties Within and Outside of the Diabetes Belt.” Diabetes Care. January 27, 2020. DOI https://doi.org/10.2337/dc19-0874