Medicaid expansion reduced number of uninsured in Diabetes Belt

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More than 11 percent of adults in the Diabetes Belt, a swath of the southeast that includes Virginia, has diabetes.

A new study is showing that Medicaid expansion, politically unpopular in the southeast, is helping reduce the numbers of low-income residents without insurance who have diabetes.

Go figure: access to healthcare is a key factor.

Yeah, I know.

“With increased access to care, patients are more likely to receive the care they need to prevent diabetes or at least slow the progression of the disease,” said Jennifer M. Lobo, PhD, of the University of Virginia School of Medicine’s Department of Public Health Sciences, one of the researchers in the study group.

“Addressing complications of diabetes as early as possible through regular preventive care can greatly improve quality of life,” Lobo said.

Prior to the Affordable Care Act, the Diabetes Belt counties had higher uninsured rates than other areas, but that was erased by 2014 through Medicaid expansion.

The Diabetes Belt got its name because of its higher incidence of diabetes, which is a key factor in lower life expectancy in the region.

To get a sense of the impact of Medicaid expansion both in and outside the Belt, the researchers looked at uninsured rates among adults age 64 or younger with household incomes equal to or less than 138 percent of the federal poverty line.

In 2012, 39.3 percent of those in the Diabetes Belt were uninsured, compared with 33.9 percent outside the belt. Those numbers fell to 13.1 percent and 15.1 percent, respectively, in 2016.

There was a control group to compare to in states that did not immediately expand Medicaid, a list that unfortunately includes Virginia, which finally voted to expand Medicaid in 2018.

By 2016, uninsured rates were 15 percent higher in states that had not expanded Medicaid, the researchers report.

“States that expanded Medicaid achieved an absolute reduction of 20 percentage points in uninsured rates, while states that did not achieved 13 percent reduction,” the researchers write in a new paper outlining their findings.

Broadening their scope to look at all income levels, the researchers found that Medicaid expansion led to a 4.8 percent overall reduction of the uninsured rate in the Diabetes Belt.

While additional research is needed to determine if Medicaid expansion led to improved care and outcomes, the researchers conclude: “Medicaid expansion has had its intended effect of increasing insurance coverage among the low-income populations.”

They note, “Eight states that contain Diabetes Belt counties are not expanding Medicaid at this time. Medicaid expansion may help realize more equity in insurance coverage between Belt and non-Belt areas in these states.”

“We hope that our findings encourage policy makers to maintain and expand policies that increase health insurance coverage, particularly in areas like the Diabetes Belt which have a greater prevalence of the disease,” Lobo said. “Whether increased insurance coverage is enough to narrow the gaps in diabetes prevalence between the Diabetes Belt and the rest of the country is yet to be seen, but one thing is clear. The Diabetes Belt is an area that need more attention by policy makers.”

With reporting by Chris Graham


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