Study: U.S. healthcare reform has led to a diabetes diagnosis surge in states with Medicaid expansion

Print 24 March 2015
Stacy Lawrence / Fierce Medical Devices

The enactment of the Affordable Care Act with its expansion of Medicaid benefits has led to an uptick in diabetes diagnoses by almost one-quarter, according to a study of deidentified test results from Quest Diagnostics ($DGX). That's in states that opted to expand Medicaid under the new law during the first 6 months of 2014 as compared to the first 6 months of 2013.

In states that did not accept the Medicaid expansion, the number of diabetes diagnoses expanded by a scant 0.4%. As of February, 22 states and the District of Columbia had accepted expanded Medicaid coverage under ACA, while another 6 opted for an expansion under an alternative plan. And 17 states decided not to expand Medicaid coverage, while another 5 were considering it, according to an analysis by healthcare industry group The Advisory Board.

Almost all the southern U.S. states, many of which have some of the highest rates of diabetes and obesity in the country, rejected the Medicaid expansion under the ACA.

"This seminal study demonstrates that the ACA promotes earlier diagnosis of one of the most prevalent and treatable chronic health conditions in the United States," Dr. Vivian Fonseca, study co-investigator and professor of medicine at Tulane University School of Medicine, said in a statement.

"But these benefits were not shared equally across states. This study demonstrates the need for additional debate on the merits of health care reform to promote equal access to health services," he cautioned.

Starting on Jan. 1, 2014, the ACA expanded Medicaid to uninsured adults with an income at or below 138% of the federal poverty level. At the time of the Quest analysis, 26 states had agreed to expand Medicaid.

Specifically, the study looked at deidentified test results of 434,288 patients with newly identified diabetes who had been tested by Quest Diagnostics. The diabetes diagnoses were up 23% during the first 6 months of last year as compared to the same period a year prior. In addition, the newly identified patients with diabetes were more likely to be identified at earlier stages of the disease in states with Medicaid expansion than in those without it.

"Not only did states with expanded Medicaid programs catch more people with diabetes, they caught them at earlier stages, when the disease is more manageable," study lead investigator Dr. Harvey Kaufman, senior medical director at Quest, said in a statement. "These findings likely apply to other chronic conditions, like heart and chronic kidney disease, for which early diagnosis and treatment strongly correlate with better health outcomes."

Older patients and men were the most likely to benefit from increased rates of diagnosis. The researchers think the gender gap could be due to higher rates of healthcare utilization by women ahead of the Medicaid expansion.

The researchers at Quest deidentified test results for people age 19 to 64 in the U.S. who were newly diagnosed with diabetes. This was defined based on at least one blood test for diabetes marker hemoglobin A1c that was greater than 6.3% or a new patient classification for diabetes mellitus.

In the U.S., about 1.7 million people are diagnosed with diabetes annually. The cost of healthcare and lost productivity associated with diabetes in the country is estimated to be about $322 billion a year.

"Our study demonstrates the value of objective insights gleaned from aggregate diagnostic data for informing population health strategies that can promote better health outcomes," Dr. Jay Wohlgemuth, SVP and CSO of research, development and medical at Quest Diagnostics, said in a statement. "We hope that the use of our population data in this research enlightens the decisions of policy makers considering reforms in the area of preventive health services."

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