Diabetes is a chronic health condition contributing to a substantial burden of disease. According to the Robert Wood Johnson Foundation, 10.9 million people were newly insured by Medicaid between ...2013 and 2016. Considering this coverage expansion, the Affordable Care Act (ACA) could significantly affect people with diabetes in their management of the disease. This study evaluates the impact of the Medicaid expansion under the ACA on diabetes management.
This study includes 22,335 individuals with diagnosed diabetes from the 2011 to 2016 Behavioral Risk Factor Surveillance System. It uses a difference-in-differences approach to evaluate the impact of the Medicaid expansion on self-reported access to health care, self-reported diabetes management, and self-reported health status. Additionally, it performs a triple-differences analysis to compare the impact between Medicaid expansion and nonexpansion states considering diabetes rates of the states.
Significant improvements in Medicaid expansion states as compared with non-Medicaid expansion states were evident in self-reported access to health care (0.09 score;
= 0.023), diabetes management (1.91 score;
= 0.001), and health status (0.10 score;
= 0.026). Among states with large populations with diabetes, states that expanded Medicaid reported substantial improvements in these areas in comparison with those that did not expand.
The Medicaid expansion has significant positive effects on self-reported diabetes management. While states with large diabetes populations that expanded Medicaid have experienced substantial improvements in self-reported diabetes management, non-Medicaid expansion states with high diabetes rates may be facing health inequalities. The findings provide policy implications for the diabetes care community and policy makers.
Background: Tertiary care pediatric Weight Management Clinics (WMC) have a high no-show rate for the first appointment. Limited evidence suggests that an orientation session prior to the first WMC ...visit can improve attendance rates. Methods: A multidisciplinary team utilized an A3 quality improvement framework to identify root causes and continuous improvement approaches. Our first Plan-Do-Study-Act cycle included design of a virtual WMC pre-visit group orientation (JUMP START) which included information about WMC components, providers, visit frequency, lifestyle intervention, advanced treatment options, and key nutrition changes associated with healthier weight (August 2021). Follow-up qualitative interviews were done with a subset of parents/ caregivers. Primary outcome measure is no-show rate for initial WMC visits. Results: 479 patients (50% of referrals) attended JUMP START in the first 8 months. Insurance status was 36% commercial, 61% Medicaid and 3% self-pay. The WMC initial visit no-show rate decreased from a baseline mean of 39% (April-July 2021) to a mean of 12.9% (October 2021 -March 2022). Among patients attending JUMP START, 55% scheduled and attended an initial WMC appointment (insurance type: 42% commercial, 57% Medicaid and 1% self-pay). During qualitative interviews, parents/caregivers favorably rated their JUMP START visit. Areas for improvement identified included not being able to discuss specific questions about their child due to the group nature of the session and technical issues with connection and participation. Conclusions: A pre-initial visit virtual orientation session led to improvements in no show rates at initial WMC visits. However, health disparities in WMC attendance rates persist and ongoing improvement is needed. Next steps include exploring additional root causes, decreasing disparities in initial WMC visit attendance rate, and addressing parent/caregiver identified barriers to virtual orientation attendance.
We examined the effect of the expansion of Medicaid eligibility under the Affordable Care Act on health insurance coverage and labor supply of low-educated and low-income adults. We found that the ...Medicaid expansions were associated with large increases in Medicaid coverage, for example, 50 percent among childless adults, and corresponding decreases in the proportion uninsured. There was relatively little change in private insurance coverage, although the expansions tended to decrease such coverage slightly. In terms of labor supply, estimates indicated that the Medicaid expansions had little effect on work effort despite the substantial changes in health insurance coverage. Most estimates suggested that the expansions increased work effort, although not significantly.
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