TY - JOUR
T1 - The affordable care act
T2 - Effects of insurance on diabetes biomarkers
AU - Marino, Miguel
AU - Angier, Heather
AU - Springer, Rachel
AU - Valenzuela, Steele
AU - Hoopes, Megan
AU - O’malley, Jean
AU - Suchocki, Andrew
AU - Heintzman, John
AU - Devoe, Jennifer
AU - Huguet, Nathalie
N1 - Publisher Copyright:
© 2020 by the American Diabetes Association.
PY - 2020/9
Y1 - 2020/9
N2 - OBJECTIVE We sought to understand how Affordable Care Act (ACA) Medicaid expansion insurance coverage gains are associated with changes in diabetes-related biomarkers. RESEARCH DESIGN AND METHODS This was a retrospective observational cohort study using electronic health record data from 178 community health centers (CHCs) in the ADVANCE (Accelerating Data Value Across a National Community Health Center Network) network. We assessed changes in diabetes-related biomarkers among adult patients with diabetes in 10Medicaid expansion states (n 5 25,279), comparing newly insured with continuously insured, discontinuously insured, and continuously uninsured patients pre– to post–ACA expansion. Primary outcomes included changes from 24 months pre-to 24 months post-ACA in glycosylated hemoglobin (HbA1c), systolic (SBP) and diastolic (DBP) blood pressure, and LDL cholesterol levels. RESULTS Newly insured patients exhibited a reduction in adjusted mean HbA1c levels (8.24% [67 mmol/mol] to 8.17% [66 mmol/mol]), which was significantly different from continuously uninsured patients, whose HbA1c levels increased (8.12% [65 mmol/ mol] to 8.29% [67 mmol/mol]; difference-in-differences [DID] 20.24%; P <0.001). Newly insured patients showed greater reductions than continuously uninsured patients in adjusted mean SBP (DID 21.8 mmHg; P <0.001), DBP (DID 21.0 mmHg; P <0.001), and LDL (DID 23.3 mg/dL; P 0.001). Among patients with elevated HbA1c in the 3 months prior to expansion, newly insured patients were more likely than continuously uninsured patients to have a controlled HbA1c measurement by 24 months post-ACA (hazard ratio 1.25; 95% CI 1.02–1.54]. CONCLUSIONS Post-ACA, newly insured patients had greater improvements in diabetes-related biomarkers than continuously uninsured, discontinuously insured, or continuously insured patients. Findings suggest that health insurance gain via ACA facilitates access to appropriate diabetes care, leading to improvements in diabetes-related biomarkers.
AB - OBJECTIVE We sought to understand how Affordable Care Act (ACA) Medicaid expansion insurance coverage gains are associated with changes in diabetes-related biomarkers. RESEARCH DESIGN AND METHODS This was a retrospective observational cohort study using electronic health record data from 178 community health centers (CHCs) in the ADVANCE (Accelerating Data Value Across a National Community Health Center Network) network. We assessed changes in diabetes-related biomarkers among adult patients with diabetes in 10Medicaid expansion states (n 5 25,279), comparing newly insured with continuously insured, discontinuously insured, and continuously uninsured patients pre– to post–ACA expansion. Primary outcomes included changes from 24 months pre-to 24 months post-ACA in glycosylated hemoglobin (HbA1c), systolic (SBP) and diastolic (DBP) blood pressure, and LDL cholesterol levels. RESULTS Newly insured patients exhibited a reduction in adjusted mean HbA1c levels (8.24% [67 mmol/mol] to 8.17% [66 mmol/mol]), which was significantly different from continuously uninsured patients, whose HbA1c levels increased (8.12% [65 mmol/ mol] to 8.29% [67 mmol/mol]; difference-in-differences [DID] 20.24%; P <0.001). Newly insured patients showed greater reductions than continuously uninsured patients in adjusted mean SBP (DID 21.8 mmHg; P <0.001), DBP (DID 21.0 mmHg; P <0.001), and LDL (DID 23.3 mg/dL; P 0.001). Among patients with elevated HbA1c in the 3 months prior to expansion, newly insured patients were more likely than continuously uninsured patients to have a controlled HbA1c measurement by 24 months post-ACA (hazard ratio 1.25; 95% CI 1.02–1.54]. CONCLUSIONS Post-ACA, newly insured patients had greater improvements in diabetes-related biomarkers than continuously uninsured, discontinuously insured, or continuously insured patients. Findings suggest that health insurance gain via ACA facilitates access to appropriate diabetes care, leading to improvements in diabetes-related biomarkers.
UR - http://www.scopus.com/inward/record.url?scp=85090533740&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85090533740&partnerID=8YFLogxK
U2 - 10.2337/dc19-1571
DO - 10.2337/dc19-1571
M3 - Article
C2 - 32611609
AN - SCOPUS:85090533740
SN - 0149-5992
VL - 43
SP - 2074
EP - 2081
JO - Diabetes care
JF - Diabetes care
IS - 9
ER -