According to a recent study in the journal Diabetes Care, the states that are under the Affordable Care Act (ACA) and have expanded their Medicaid programs are detecting a higher number of patients with previously undiagnosed diabetes. Thanks to these enacted measures, the treatment of these patients is starting earlier, reducing the risk of developing future complications and other adverse outcomes.
An expanded Medicaid eligibility option to include non-elderly adults with incomes equivalent to 138 percent of the federal poverty level was given; 26 states chose to do so and 24 did not. The study identified an increase in newly identified diabetic patients in both groups, but those states that expanded their Medicaid programs saw a 23 percent increase compared to a 0.4 percent increase in those that did not expand their programs.
“The division of states created an opportunity to examine the impact of Medicaid expansion on specific health metrics, such as detection of disease,” noted the authors of the study. Newly diagnosed patients with both type 1 and 2 diabetes were identified through the Quest Diagnostics database. Diabetes was chosen since it affects a large percentage of the population and since “aggressive prevention and treatment programs have been shown to improve outcomes,” they added.
“Clearly, expanding Medicaid has allowed those 26 states that did so to identify a large number of people who previously did not know they were living with diabetes,” said Vivian Fonseca, from the Tulane University Health Sciences Center. “Early identification can be potentially life-saving for people with diabetes, and can at the very least greatly increase the chances of preventing or delaying complications. Data on prevention of complications comes from several trials funded by the National Institutes of Health, American Diabetes Association and others. In the long term, such prevention of complications has been shown to be cost saving, since the complications — including blindness, amputations and kidney failure requiring dialysis or transplant — are extremely expensive.”
“Access to affordable, adequate health coverage is critically important for all people with, and at risk for, diabetes,” said Robert Ratner from the American Diabetes Association. “The study demonstrated the benefit of new Medicaid coverage in identifying people with diabetes and initiating therapy in those historically not having health insurance. The state-by-state expansion of Medicaid benefits under the Affordable Care Act provides a natural experiment to elucidate case finding in diabetes and the initiation of therapy to minimize costly complications. By increasing access to health care, Medicaid expansion allows people to know their status and receive life-preserving treatments to help improve their quality of life and to prevent serious and costly complications. We hope that those states that have not yet expanded their Medicaid coverage will see the potential advantages of improved health and productivity for their citizens and initiate their own Medicaid expansion.”
According to former studies, 1 in every 10 dollars spent in health care in the U.S. in 2012 were due to diabetes.
“The data demonstrate the benefits of Medicaid expansion, yet nearly half of our states have chosen not to expand this benefit to their citizens. The real-world benefits and costs of Medicaid expansion merit additional research and civil debate. And perhaps most important, their results should be used to guide health policy to address the growing burden of chronic diseases,” said William Cefalu and William Herman, both experts in the area, in a press release.
There were more men among the newly diagnosed diabetes patients (25 percent men for the states with the expanded states and 4.6 in the others; 22 percent women in expanded states and 1.4 non-expanded). Patients between 19 and 49 years old were linked to an increase of 15 percent in the expanded states and no alterations in the others; older patients with ages between 50 and 64 years were linked to an increase of 31 percent (expansion states), and 0.5 percent (non-expansion states).
