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Diabetes Diagnoses Surge in States That Expanded Medicaid Under Affordable Care Act

Study suggests health care reform increased access to preventive health services

States that have expanded their Medicaid programs under the Patient Protection and Affordable Care Act (PPACA) are identifying an increased number of people with previously undiagnosed diabetes, allowing them to begin treatment earlier and potentially reducing complications and other negative outcomes, according to a new study published in the May issue of Diabetes Care.

The release of the study coincides with the fifth anniversary of the PPACA, which expanded Medicaid eligibility to reach nearly all nonelderly adults with incomes at or below 138% of the federal poverty level (approximately $16,105 for individuals), while giving states the option of offering this expanded coverage. Twenty-six states chose to do so, while 24 states did not. The study compared increases in patients with newly diagnosed diabetes in both groups, and found a 23% increase in newly diagnosed diabetes patients in states that expanded their Medicaid programs compared with a 0.4% increase in states that did not.

“The division of states created an opportunity to examine the impact of Medicaid expansion on specific health metrics, such as detection of disease,” the authors write. Their study used the Quest Diagnostics database to identify newly diagnosed patients with both type-1 and type-2 diabetes. Diabetes was chosen, the authors note, because it has such a large at-risk population and because “aggressive prevention and treatment programs have been shown to improve outcomes.”

“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 Vivian Fonseca, MD, professor of medicine and pharmacology at the 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. Data on prevention of complications come from several trials funded by the National Institutes of Health, American Diabetes Association, and others. In the long term, such prevention of complications has been shown to be cost saving, since the complications –– including blindness, amputations, and kidney failure requiring dialysis or transplant –– are extremely expensive.”

A commentary accompanying the study notes that diabetes consumed one in every 10 health care dollars spent in the U.S. in 2012.

In the new study, the rise in newly identified diabetes patients was higher for men (25% in expansion states versus 4.6% percent in non-expansion states) than for women (22% in expansion states, with a decline of 1.4% in non-expansion states). Younger patients (19 to 49 years of age) saw an increase of 15% in the expansion states, with no change in non-expansion states, whereas older patients (50 to 64 years of age) saw an increase of 31% in the expansion states compared with 0.5% in the non-expansion states.

Source: EurekAlert; March 23, 2015.

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