The Impact of the Affordable Care Act Medicaid Expansion on Type 2 Diabetes Diagnosis and Treatment: A National Survey of Physicians

Abstract

Introduction-In 2014, the Affordable Care Act (ACA) provided funding for states to expand Medicaid coverage to include citizens who earned up to 138% of the federal poverty line. We sought to ascertain whether physicians practicing in Medicaid expansion states reported an increase in Medicaid or newly insured patients with type 2 diabetes in their panels, compared to physicians practicing in non-expansion states. Methods-We conducted a 55-question cross-sectional survey of 356 physicians providing outpatient care for adults with type 2 diabetes. We used adjusted multivariate logistic regression analyses to compare responses from physicians who practiced in expansion vs. non-expansion states regarding whether they observed an increase since 2014 in 1) the number of Medicaid or newly insured patients with diabetes and 2) the number of additional newly or previously diagnosed patients who were newly receiving care, in their panels, adjusting for physician, practice, and patient-level characteristics, weighted for the U.S. physician population. Results-41% of eligible recipients responded. 64.2% of physicians who practice in an expansion state report an increase in Medicaid or newly insured patients with diabetes compared with 46.1% who practice in non-expansion states (p = 0.05; Table 2). Conclusion-Compared with physicians who practice in non-expansion states, physicians who practice in Medicaid expansion states are more likely to report an increase in the number of Medicaid or newly insured patients with diabetes in their practice since 2014. The increased

“Association between Median Household Income, State Medicaid Expansion Status, and COVID-19 Outcomes Across US Counties”

“…We posit that improved access to healthcare insurance such as Medicaid expansion could lead to lower uninsured rates among low-income individuals, improving access to healthcare, thereby lowering the adverse impact of COVID-19 in low-income communities. 23,35,36 Limitations and Strengths This is a nationwide study, that utilized representative data of US communities suitable to assess outcomes as it relates to policy. Study limitations include its observational design, inability to conclude causality and the potential for residual confounding despite our careful control of known confounders.…”

“…We posit that improved access to healthcare insurance such as Medicaid expansion could lead to lower uninsured rates among low-income individuals, improving access to healthcare, thereby lowering the adverse impact of COVID-19 in low-income communities. 23,35,36…”

Association between median household income, state Medicaid expansion status, and COVID-19 outcomes across US counties

“…A review of literature shows that individuals without health insurance are less likely to seek health care even when in need [33]. In contrast, it has been shown that when they could afford care, individuals were more likely to utilize healthcare resources [23,[34][35][36]. Therefore, while a proportion of population in high income communities are able to afford insurance regardless of state Medicaid expansion status, exemplified by similar mortality rates between counties in the highest-income quartiles between Medicaid vs. non-Medicaid expansion states, the highest mortality rate gap is observed in the lowest-income quartiles.…”