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

Details

• Alternative Title:
  J Am Board Fam Med
• Personal Author:
  Huguet, Nathalie ; Springer, Rachel ; Marino, Miguel ; Angier, Heather ; Hoopes, Megan ; Holderness, Heather ; DeVoe, Jennifer E
• 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.
  
  
• Subjects:
  Adult Community Health Centers Diabetes Mellitus Electronic Health Records Female Health Services Accessibility Humans Insurance, Physician Services Longitudinal Studies Male Medicaid Medically Uninsured Middle Aged Patient Protection And Affordable Care Act Primary Health Care Safety-net Providers United States Young Adult

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• Source:
  J Am Board Fam Med. 31(6):905-916
• Pubmed ID:
  30413546
• Pubmed Central ID:
  PMC6329010
• Document Type:
  Journal Article
• Funding:
  U18DP006116/ACL/ACL HHSUnited States/ ; R01 CA204267/CA/NCI NIH HHSUnited States/ ; R01 HS024270/HS/AHRQ HHSUnited States/ ; U18 DP006116/DP/NCCDPHP CDC HHSUnited States/ ; R01 CA181452/CA/NCI NIH HHSUnited States/
• Volume:
  31
• Issue:
  6
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:c0f33fd339623d54e168458a97f92131d78cc097127ff0ace0c1eccfe3ea7773
• Download URL:
  https://stacks.cdc.gov/view/cdc/61894/cdc_61894_DS1.pdf
• File Type:
  [PDF - 127.27 KB ]