Has the expansion of Medicaid improved control of diabetes and hypertension?


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New study assesses benefits of expanded Medicaid eligibility. Joe_Potato / Getty Images
  • In the United States, since the expansion of Medicaid eligibility under the Affordable Care Act (ACA), some states have opted and others have refused to participate.
  • A new study finds that measures of blood pressure and blood sugar control improved in expanding states compared to non-expanding states.
  • Improvements in blood pressure and blood sugar control are most important for black and Hispanic residents.

As part of the ACA, US states were given the opportunity to extend Medicaid coverage to more people to reduce the number of people without health insurance.

As of September 2021, 39 states, including Washington, DC, had adopted Medicare extension. Currently, 12 states have not extended eligibility for Medicaid.

Blood pressure and blood sugar control measures have improved in states participating in the expansion of Medicaid, a new study finds.

The recent study looked at how well individuals’ blood pressure and blood sugar levels have been monitored over the past 5 years at federally accredited health centers (FQHC) in the 26 states that have extended Medicaid by now. 2014 and in states without expansion.

Dr Megan Cole Brahim, lead author of the study and co-director of the Medicaid Policy Lab at the Boston University (BU) School of Public Health, says:

“Once a patient has health insurance coverage, the associated health outcomes probably don’t improve overnight. It takes time for patients to become better connected to care and the management of care while having access to prescription drugs. It also takes time for FQHCs to invest new revenue for patients in things that improve the quality of care. “

“Our results suggest that over the longer term, expanding Medicaid eligibility may improve key chronic disease health outcomes for marginalized low-income populations, which is an important consideration for the 12 states that do not. ‘have yet to embrace the expansion of Medicaid. “

– Dr Megan Cole Brahim

The study appears in the journal JAMA Health Forum.

Monitoring of blood pressure and blood sugar is essential for the detection and management of hypertension and diabetes, respectively.

According to the Centers for Disease Control and Prevention (CDC), of the 108 million people with hypertension in the United States, only 1 of 4 have their condition under control. This puts them at high risk for heart attack and stroke.

In addition, diabetes is the seventh leading cause of death in the United States Thirty-four million people in the United States have diabetes, although one in five people do not know they have it. Of the 88 million more people who suffer from prediabetes, 84% are unaware of their risk.

Prior to the expansion of Medicaid eligibility, assistance was only available to people aged 65 and over, unless they had children under the age of 18. Eligibility was calculated based on income, household size, disability, family status and other factors.

Millions of people in the United States from low-income households could not afford health insurance coverage.

Dr Brahim said Medical News Today, “The main difference between expanding and non-expanding states is that adults without children [earning] up to 138% of the federal poverty level are eligible for Medicaid in expanding states, while this population does not have access to coverage in states that have not expanded eligibility for this group.

As of December 2020, 14.8 million newly eligible people were enrolled in Medicaid nationwide.

Between the expansion of Medicaid and the ACA Marketplace, 31 million people in the United States have obtained health insurance, and the rate of uninsured for citizens who are not considered senior citizens has increased from 48, 2 million to 28.2 million people.

In the current study, researchers analyzed data from 946 FQHCs that serve 18.9 million patients per year in the states studied.

Together, all FQHCs nationwide serve 30 million people in the United States from low-income households each year, regardless of their ability to pay for services.

The FQHC serve, according to the study, “1 in 5 people registered with Medicaid, 1 in 5 rural residents and 1 in 3 people with an income below the federal poverty line.”

Previous research has linked the expansion of Medicaid to improved service capacity and quality of care in FQHCs in expanding states. Dr Brahim shared with MNT two possible explanations:

“First, more patients have had access to health insurance and therefore regular care, which in turn improves health. Second, the FQHC received more income for patients because more patients had coverage, which could be invested in increased staffing, quality improvement programs, and other resources that improve quality for all. patients.

FQHCs in expansion states included in the study saw a 9.2 percentage point (PP) reduction in uninsured patients over the 5-year period, compared to FQHCs in states without expansion of Medicaid.

The number of uninsured people has also declined in states that have not expanded eligibility, although to a lesser extent.

Co-author Timothy Levengood, a doctoral student in the Department of Health Law, Policy and Management at the BU School of Public Health, said MNT that “this is largely due to another major policy change in the context of the [ACA], in which low-income patients in all 50 states could purchase low-cost (subsidized) private insurance plans on Marketplace Grants if they made too much money for Medicaid, but not enough to afford them – even private health insurance.

The study found that over the 5-year period, expansion states saw an overall comparative improvement of 1.61 PP in blood pressure control and a 1.84 PP improvement in blood pressure control. blood sugar.

Measures to control hypertension and diabetes improved most steadily for black and Hispanic people. By year five, the comparative improvement in hypertension control was 3.38 PP for Blacks and 3.03 for Hispanics.

Improvements in diabetes measures also increased steadily to reach 3.88 PP for Blacks and 2.93 PP for Hispanics.

Even with these improvements, however, inequalities in health care remain. Levengood told the BU School of Public Health:

“We have a good feeling that these disparities reflect the political, economic and social systems in which we live and which currently do not provide equal opportunities in health on the basis of skin color. Whether you can afford to see a doctor regularly and get these conditions under control goes a long way in determining whether you will develop or die from these chronic conditions. It is important to study relevant policy changes to these systems to address these disparities and create a more equitable society for all Americans.


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