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- Title
The Affordable Care Act: Effects of Insurance on Diabetes Biomarkers.
- Authors
Marino, Miguel; Angier, Heather; Springer, Rachel; Valenzuela, Steele; Hoopes, Megan; O'Malley, Jean; Suchocki, Andrew; Heintzman, John; DeVoe, Jennifer; Huguet, Nathalie
- Abstract
<bold>Objective: </bold>We sought to understand how Affordable Care Act (ACA) Medicaid expansion insurance coverage gains are associated with changes in diabetes-related biomarkers.<bold>Research Design and Methods: </bold>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 10 Medicaid expansion states (n = 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.<bold>Results: </bold>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] -0.24%; P < 0.001). Newly insured patients showed greater reductions than continuously uninsured patients in adjusted mean SBP (DID -1.8 mmHg; P < 0.001), DBP (DID -1.0 mmHg; P < 0.001), and LDL (DID -3.3 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].<bold>Conclusions: </bold>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.
- Subjects
UNITED States; PATIENT Protection &; Affordable Care Act; GLYCOSYLATED hemoglobin; MEDICALLY uninsured persons; ELECTRONIC health records; BIOMARKERS; MEDICAID; ECONOMIC impact; DIAGNOSIS of diabetes; INSURANCE law; MEDICAID statistics; HEALTH insurance statistics; HEALTH insurance laws; HEALTH insurance &; economics; PATIENT Protection &; Affordable Care Act -- Economic aspects; INSURANCE statistics; RESEARCH; RESEARCH methodology; DIABETES; RETROSPECTIVE studies; COMMUNITY health services; MEDICAL cooperation; EVALUATION research; COMPARATIVE studies; RESEARCH funding; INSURANCE; LONGITUDINAL method; LEGISLATION; ECONOMICS; LAW
- Publication
Diabetes Care, 2020, Vol 43, Issue 9, p2074
- ISSN
0149-5992
- Publication type
journal article
- DOI
10.2337/dc19-1571