This is a companion article to the feature, “Diabetes: In Search of Early Intervention.”
A 2015 Health Trends study conducted by Quest Diagnostics found that diabetes diagnoses surged during 2014 in states that expanded Medicaid under the Patient Protection and Affordable Care Act.1 The study suggests that healthcare reform has increased access to preventive health services, but only in states that expanded Medicaid. Key findings of the study include the following:
- Diabetes diagnosis rates surged in states that expanded Medicaid. Newly identified diabetes in Medicaid patients surged 23.2% in Medicaid expansion states, but increased just 0.4% in states that chose not to expand.
- People with diabetes were caught at earlier stages in states that expanded Medicaid. HbA1c blood levels generally correspond to disease severity. The Quest scientists found lower HbA1c levels in newly identified patients in expansion states versus those in nonexpansion states. Patients with diabetes may experience better disease management when diagnosed and treated at an earlier stage.
- Men had higher rates of diabetes diagnosis than women. Diagnoses of Medicaid-enrolled men increased 25.5% in the expansion states, while diagnoses for women increased 22%. Among Medicaid enrollees in nonexpansion states, rates of diagnoses for men increased 4.6%, but decreased 1.4% for women. The Quest researchers hypothesize that because women tend to use health services more than men, women with diabetes may have been more likely to have been previously diagnosed. Men may also have higher diabetes risk than women.
- Older patients experienced the highest rates of diabetes diagnoses in Medicaid expansion states. For older patients (50–64 years of age), the increase of Medicaid patients with newly identified diabetes was 31.2% in the expansion states, compared to only 0.5% in the nonexpansion states. For younger patients (19–49 years of age), Medicaid patients with newly identified diabetes increased nearly 15% in the expansion states, with essentially no change in the nonexpansion states.
In an accompanying editorial, William H. Herman, MD, MPH, professor of epidemiology and internal medicine at the University of Michigan, and William T. Cefalu, MD, chief and professor of endocrinology, diabetes, and metabolism at the Louisiana State University Medical School and editor in chief of Diabetes Care, write that the Quest Diagnostics study demonstrates that Medicaid expansion increases the number of low-income Americans with newly identified diabetes and will likely improve their outcomes.2
“The data demonstrate the benefits of Medicaid expansion, yet nearly half of our states have chosen not to expand this benefit to their citizens,” they write. “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.”
- Kaufman HW, Chen Z, Fonseca VA, McPhaul MJ. Surge in newly identified diabetes among Medicaid patients in 2014 within Medicaid expansion states under the Affordable Care Act. Diabetes Care. 2015;38(5):833–837; doi: 10.2337/dc14-2334.
- Herman WH, Cefalu WT. Health policy and diabetes care: is it time to politics aside? Diabetes Care. 2015;38(5):743–745; doi: 10.2337/dc15-0348.