Expanding Medicaid and catching diabetes

When the Affordable Care Act was penned into law, the hope was that reducing the cost of health insurance and eliminating copays and deductibles for preventative care would lead to increased use of the health system by the previously uninsured.  The goal?  To help prevent some of the nation’s costliest diseases.  New evidence suggests that might actually be happening.

A new study reports that states that embraced the Affordable Care Act’s Medical Expansion provisions identified a surge in new diabetes cases among poor Americans, while the number of new diabetes cases barely budged in states that did not expand the insurance program for the poor.  More importantly, many of the cases were identified early in the disease’s course, at a time when diet and exercise changes can be most beneficial and effective.

About one in 10 Americans have diabetes, and nearly a third of cases have yet to be diagnosed.  Diabetes is known to be an independent risk factor for coronary artery disease and heart attacks, while in its end stages is associated with blindness and kidney failure, and is one of the leading indications for foot and leg amputations.  The CDC estimates that diabetes accounts for $176 billion in annual medical costs.

The study by Quest Diagnostics analyzed laboratory test results from all 50 states using hemoglobin A1c as a surrogate for diabetes, a test that measures long term glucose control.  In the states that expanded Medicaid, newly identified diabetes rose by 23%, while the diagnoses only rose by 0.4% in states that did not expand.

The researchers admit that their study had several limitations – notably that the data is not nationally representative but rather that of lab results for one company.  They point out however that the results were unlikely to be from large demographic shifts or from an sudden increase in Quest’s market share.  The total number of patients in the study rose by 1.6%, roughly in line with the increase in the national population.  Meanwhile, Quest’s increase in market share between 2013 and 2014 was virtually negligible.

Early detection of diabetes is critically important to preventing the severe long-term consequences of the disease, particularly among the poor – who are likely to have the disease without knowing it.


About justgngr

the ramblings of a medical professional by day, judgmental ginger by night
This entry was posted in health policy, medicine and tagged , , . Bookmark the permalink.

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