Trends in Uninsured Rates Before and After Medicaid Expansion in Counties Within and Outside of the Diabetes Belt

Abstract

To examine trends in uninsured rates between 2012 and 2016 among low-income adults aged <65 years and to determine whether the Patient Protection and Affordable Care Act (ACA), which expanded Medicaid, impacted insurance coverage in the Diabetes Belt, a region across 15 southern and eastern U.S. states in which residents have high rates of diabetes. RESEARCH DESIGN AND METHODSData for 3,129 U.S. counties, obtained from the Small Area Health Insurance Estimates and Area Health Resources Files, were used to analyze trends in uninsured rates among populations with a household income £138% of the federal poverty level. Multivariable analysis adjusted for the percentage of county populations aged 50-64 years, the percentage of women, Distressed Communities Index value, and rurality. RESULTSIn 2012, 39% of the population in the Diabetes Belt and 34% in non-Belt counties were uninsured (P < 0.001). In 2016 in states where Medicaid was expanded, uninsured rates declined rapidly to 13% in Diabetes Belt counties and to 15% in non-Belt counties. Adjusting for county demographic and economic factors, Medicaid expansion helped reduce uninsured rates by 12.3% in Diabetes Belt counties and by 4.9% in non-Belt counties. In 2016, uninsured rates were 15% higher for both Diabetes Belt and non-Belt counties in the nonexpansion states than in the expansion states. CONCLUSIONSACA-driven Medicaid expansion was more significantly associated with reduced uninsured rates in Diabetes Belt than in non-Belt counties. Initial disparities in uninsured rates between Diabetes Belt and non-Belt counties have not existed since 2014 among expansion states. Future studies should 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.The Diabetes Belt is an important region for public health interventions to reduce health disparities (1).

Health Care Coverage and Glycemic Control in Young Adults With Youth-Onset Type 2 Diabetes: Results From the TODAY2 Study

“…Lower mean HbA 1c (better glycemic control) has been reported in adults with diabetes treated with insulin or oral medications as well as in adults diagnosed with diabetes but untreated (for all adults aged $20 years, 7.4% and 6.3%, respectively, and for the subgroup of younger adults aged 20-44 years, 8.1% and 6.4%, respectively) (29). A smaller percent of adults (16% [95% CI [13][14][15][16][17][18]) aged $18 years is also described as having poor glycemic control (defined as HbA 1c .9.0%) (30). This highlights important differences between youthonset and adult-onset type 2 diabetes, with youth onset being associated with worse glycemic control and early development of complications (1)(2)(3)(4)(5)(6)(7)10).…”

“…Medication underuse has also been reported in adults with poor health care coverage (12). With Medicaid and private health care coverage expansion under the Affordable Care Act (ACA), there has been a reduction in uninsured rates in the 644 "Diabetes Belt" counties, which are counties in the southern and eastern U.S. that had a $11% prevalence of diabetes in 2007-2008 (13). More outpatient care and better self-reported health in adults have also been reported (14,15).…”

Are there racial differences between patients undergoing surgery for shoulder instability? Data from the Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability Group

“…The DCI is a measure of neighborhood social vulnerability and is commonly used in assessments of health care disparities. 4,22 This score has been demonstrated to be an independent risk factor for complications and death after cardiac and bariatric surgery and has been shown to improve surgical risk adjustment. 5,13,24,25 For the primary overarching comparison of white and US minority patients, continuous variables were compared between groups using 2-tailed independent t tests whereas categorical variables were compared using c 2 or Fisher exact tests as appropriate.…”

The Role of Policies in Cancer Pain, Health Disparities, and Substance Use

“…States that have expanded Medicaid coverage have seen greater declines in uninsured rates compared to states that have not expanded. [177][178][179][180] There is evidence that Medicaid expansion is related to reductions in substance use and use-related health problems. In Oregon, Medicaid expansion was associated with a six percentage-point increase in alcohol use disorder treatment rates and a 150% increase in Medicaid enrollees with alcohol use disorder.…”