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Trends in Uninsured Rates Before and After Medicaid Expansion in Counties Within and Outside of the Diabetes Belt.

Authors
  • Lobo, Jennifer M1
  • Kim, Soyoun1
  • Kang, Hyojung2
  • Ocker, Gabrielle1
  • McMurry, Timothy L1
  • Balkrishnan, Rajesh1
  • Anderson, Roger1
  • McCall, Anthony3
  • Benitez, Joseph4
  • Sohn, Min-Woong5
  • 1 Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA.
  • 2 Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL.
  • 3 Division of Endocrinology and Metabolism, Department of Medicine, School of Medicine, University of Virginia, Charlottesville, VA.
  • 4 Department of Health Management and Policy, College of Public Health, University of Kentucky, Lexington, KY.
  • 5 Department of Health Management and Policy, College of Public Health, University of Kentucky, Lexington, KY [email protected]
Type
Published Article
Journal
Diabetes care
Publication Date
Jul 01, 2020
Volume
43
Issue
7
Pages
1449–1455
Identifiers
DOI: 10.2337/dc19-0874
PMID: 31988065
Source
Medline
Language
English
License
Unknown

Abstract

To examine trends in uninsured rates between 2012 and 2016 among low-income adults aged <65 years and to determine whether the Patient Protection and Affordable Care Act (ACA), which expanded Medicaid, impacted insurance coverage in the Diabetes Belt, a region across 15 southern and eastern U.S. states in which residents have high rates of diabetes. Data for 3,129 U.S. counties, obtained from the Small Area Health Insurance Estimates and Area Health Resources Files, were used to analyze trends in uninsured rates among populations with a household income ≤138% of the federal poverty level. Multivariable analysis adjusted for the percentage of county populations aged 50-64 years, the percentage of women, Distressed Communities Index value, and rurality. In 2012, 39% of the population in the Diabetes Belt and 34% in non-Belt counties were uninsured (P < 0.001). In 2016 in states where Medicaid was expanded, uninsured rates declined rapidly to 13% in Diabetes Belt counties and to 15% in non-Belt counties. Adjusting for county demographic and economic factors, Medicaid expansion helped reduce uninsured rates by 12.3% in Diabetes Belt counties and by 4.9% in non-Belt counties. In 2016, uninsured rates were 15% higher for both Diabetes Belt and non-Belt counties in the nonexpansion states than in the expansion states. ACA-driven Medicaid expansion was more significantly associated with reduced uninsured rates in Diabetes Belt than in non-Belt counties. Initial disparities in uninsured rates between Diabetes Belt and non-Belt counties have not existed since 2014 among expansion states. Future studies should examine whether and how Medicaid expansion may have contributed to an increase in the use of health services in order to prevent and treat diabetes in the Diabetes Belt. © 2020 by the American Diabetes Association.

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