The number of new diabetes cases diagnosed among low-income Americans has surged in states that chose to expand Medicaid coverage under the Affordable Care Act (ACA) but not in those that resisted President Barack Obama’s signature health care law, according to a new study published Monday. The findings suggest that increased medical coverage for the less privileged can lead to early detection of illness and care for the sick.
Diabetes, one of the most common and costliest illnesses in the United States, provided a prime opportunity to investigate how the ACA was working, said the study’s authors. The law sought to provide Medicaid to a wider swath of adults and children living at or below 138 percent of the federal poverty line.
More than 29 million Americans have diabetes, the study said, and it cost the U.S. $245 billion in direct and indirect medical costs in 2012, according to the Centers for Disease Control. (PDF)
Researchers from the Tulane University School of Medicine and Quest Diagnostics, a New Jersey-based clinical laboratory company, wanted to compare how Medicaid patients were faring in the 26 states and the District of Columbia that had expanded coverage starting in 2014 to the 24 states that didn’t.
To do so, they analyzed data from more than 215,000 patients who had done lab testing with Quest in 2014, after the Medicaid expansion kicked in. They also looked at nearly 219,000 patients who did so in the first six months of 2013, before Medicaid was expanded.
Across all 50 states, there was a 1.6 percent increase in new diabetes cases among Medicaid patients between 2013 and 2014. But when they looked at just states that had expanded Medicaid coverage, the researchers found that the number of newly diagnosed diabetes cases increased by 23 percent — from 14,625 patients in 2013 to 18,020 patients the following year.
In the states that didn’t expand Medicaid, the number of new diabetes cases increased by only 0.4 percent, from 11,612 in 2013 to 11,653 in 2014.
Patients between the ages of 50 and 64 who lived in expansion states saw the largest increase in new diabetes cases, 31 percent. Patients in the same age group who lived in non-expansion states only saw an increase of 0.5 percent.
Those aged 19 to 49 in expansion states saw a lower, but still significant increase of 15 percent in newly diagnosed diabetes cases. However, there was no change in that age group in states that did not expand Medicaid.
The study, which was published Monday in the journal of the American Diabetes Association, said that increased access to health care among Medicaid patients had likely caused them to get their diabetes diagnosis at an earlier stage in the disease, which would help them manage it better. “This could be anticipated to lead to fewer long-term complications,” the authors wrote.
"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 Dr. Vivian Fonseca, a co-author of the study and professor at Tulane University School of Medicine. "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.”
Monday marked the fifth anniversary of the day that President Obama signed the ACA into law, but many American conservatives have fought “Obamacare,” as it’s often called, at every step.
After the Supreme Court ruled in 2012 that states could decide whether they wanted to comply with the Medicaid expansion portion of the law, many of the states that opposed the law’s initial passage — almost all with Republican governors — opted not to.
This has left gaps in insurance coverage in non-Medicaid expansion states, largely among the working poor who earn too much to qualify for Medicaid but not enough to qualify for federal subsidies on insurance plans sold on state-run exchanges.