Newly Diagnosed Diabetes Cases Rise after Medicaid Expansion Spurs Patient Testing

In states that expanded the number of low-income people eligible for Medicaid under the Affordable Care Act (ACA), the number of people with newly diagnosed type 2 diabetes increased by 23%, according to a new study that relied on Quest Diagostics’ database. The study was published online in Diabetes Care on March 23, 2015 (US News and World Report, March 23, 2015).

Researchers compared 26 states that had initially expanded Medicaid with 24 states that had not done so. The number of new diabetes diagnoses rose by 23% in the states that had expanded Medicaid compared with less than 1% in the states that didn’t expand Medicaid.

Dr Vivian Fonseca, professor of medicine and endocrinology at Tulane University, one of the study authors, said that people who don’t have health insurance do not get screened for diabetes even when they have symptoms, and he and his colleagues wondered whether Medicaid expan­sion under the ACA improved the detection of diabetes because more people had health insurance. Dr. Fonseca said that because states were allowed to choose whether to expand their Medicaid programs, about half the states did and half the state did not, creating what he called a natural experiment that allowed the investigators to compare the effect of Medicaid programs on diabetes care.

Dr Robert Ratner, chief medical officer of the American Diabetes Association, said the study also found that many of the states that did not expand Medicaid are in the so-called “diabetes belt,” a region from Louisiana to North Carolina that have a large percentage of people (as high as 20%) living with diabetes but don’t know it.