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The impact of the Affordable Care Act Medicaid expansion on visit rates for a patient population with diabetes or pre-diabetes in safety net health centers
  • Published Date:
    2018 Nov-Dec
  • Source:
    J Am Board Fam Med. 31(6):905-916
  • Language:
    English


Public Access Version Available on: November 01, 2019 information icon
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Details:
  • Keywords:
  • Pubmed ID:
    30413546
  • Pubmed Central ID:
    PMC6329010
  • Description:
    Objective

    To: (1) compare clinic-level uninsured, Medicaid-insured, and privately-insured visit rates within and between expansion and non-expansion states prior to and after the ACA Medicaid expansion among the three cohorts of patient populations; and, (2) assess whether there was a change in clinic-level overall, primary care, preventive care visits, and diabetes screening rates in expansion versus non-expansion states from pre- to post-ACA Medicaid expansion.

    Methods

    Electronic health record data on non-pregnant patients aged 19–64 with ≥1 ambulatory visit between 01/01/2012–12/31/2015 (n=483,912 in expansion states; n=388,466 in non-expansion states) from 198 primary care community health centers (CHCs) were analyzed. Using difference-in-difference methodology, we assessed changes in visit rates pre- versus post-ACA among cohort of patients with diabetes, pre-diabetes, no- diabetes.

    Results

    Rates of uninsured visits decreased for all cohorts in expansion and non-expansion states. For all cohorts, Medicaid-insured visit rates increased significantly more in expansion compared to non-expansion states, especially among pre-diabetes patients (+71%). In non-expansion states, privately-insured visit rates more than tripled for pre-diabetes cohort and doubled for the diabetes and no-diabetes cohorts. Rates for glycosolated hemoglobin screenings increased in all groups with the largest changes among no diabetes (RR=2.26, 95% CI=1.97–2.56) and pre-diabetes cohorts (RR=2.00, 95% CI=1.80–2.19) in expansion states.

    Conclusion

    The ACA reduced uninsurance and increased access to preventive care for vulnerable patients, especially those with pre-diabetes. These findings are important to consider when making decisions regarding altering the ACA.

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