Author: Jeffrey Kho


Medicaid Expansion Fights Back Against Diabetes

A newly released study suggests that states taking part in Medicaid expansion under the Affordable Care Act are doing a significantly better job at identifying patients with undiagnosed diabetes. The study found that diabetes diagnosis rates among Medicaid rates increased over 10 times as much as those living in non-expansion states1.

Put more simply, Medicaid expansion is working. People with chronic health conditions who didn’t have access to the necessary screenings and treatments are now getting access, getting diagnosed, and getting treated.

Some background: diabetes is a chronic medical condition where the body is unable to properly regulate blood glucose levels. If identified early, lifestyle changes and medical treatment can prevent serious long-term effects, but left untreated, it can cause serious damage to the brain, heart, kidneys, and nerves2.

Unfortunately, those without healthcare frequently delay care until serious symptoms manifest. Type II diabetes, which is a preventable condition, has reached epidemic proportions in the United States, affecting over 29 million Americans — with nearly a quarter remaining undiagnosed and untreated3. With such a high prevalence, it is critical that people are screened and begin treatment as soon as possible, before an outbreak of major symptoms triggers a public health emergency.

Thanks to Medicaid expansion, some states are now making huge strides in identifying the onset of diabetes. By simply expanding access to basic services routine checkups and preventative screenings, a huge swath of people with a serious medical condition can take the first steps to receiving care and controlling their diabetes.

These early signs of success indicate that Medicaid expansion has had and can continue to have a tangible and significant impact in improving the well-being of low-income Americans, and suggest that Medicaid expansion might also have similar impacts on other treatable chronic health conditions, such as high blood cholesterol and high blood pressure, ensuring that these conditions are diagnosed early and that individuals are able to make lifestyle changes and begin treatment long before serious effects manifest.

These early results point to two conclusions. Firstly, they make a strong case to the remaining states that have opted-out of Medicaid expansion to implement their own expanded Medicaid programs. Failing to expand Medicaid leaves residents disproportionately vulnerable to the effects of chronic medical conditions compared to those who live in expansion states. Secondly, in Medicaid extension states, these results also underscore the importance of appropriate follow-up following a diagnosis. In California, this means making sure Medi-Cal Managed Care provides follow-ups that link individuals with the resources to receive effective treatment, counseling, and tools for self-management to control their chronic medical conditions.


  1. The study looked at diabetes indicators among Quest Diagnostic clients in Medicaid expansion and non-expansion states in 2013 and 2014. Quest Diagnostics contracts with healthcare providers to perform routine diagnostic testing. http://care.diabetesjournals.org/content/early/2015/03/19/dc14-2334.full.pdf+html 
  2. http://www.diabetes.org/diabetes-basics/type-2/facts-about-type-2.html 
  3. Type I diabetes is an autoimmune disease which is non-preventable, but Type II diabetes develops in response to over-consumption of sugary foods and a lack of exercise. Type II is by far more prevalent. http://www.washingtonpost.com/postlive/29-million-americans-have-diabetes–but-a-quarter-of-them-dont-realize-it/2014/11/20/0831a908-6e84-11e4-ad12-3734c461eab6_story.html 

Five Years Later: Building on the Successes of the Affordable Care Act

Today, the Affordable Care Act turned five. That is something to celebrate.

In California, over 4.4 million individuals gained coverage under and the new Medi-Cal expansion, cutting the uninsured rate in half. Premiums have only risen at a slow rate, despite predictions that they would spiral out of control. Subscribers are satisfied with their coverage and are re-enrolling.

Californians are positive about the ACA.

The good news is not just limited to California: In 2010, the ACA was predicted to reduce the deficit by $143 billion. It is now predicted to lower the deficit by $152 billion in the next 9 years. 16 million Americans currently receive care through the ACA, and that number is expected to rise to 25 million in 4 years. The uninsured rate in America is now down to 12.9%, and is expected to continue to drop. The Department of Health and Human Services reported that hospitals have seen a $7.4 billion decline in uncompensated care costs among Medicaid expansion (5 billion reduction) and non-expansion states (2.4 billion reduction) following the implementation of the ACA.

In light of these successes, we must look forward to the next couple of years. While the ACA has been hugely successful in its goals, there remain many opportunities to further expand coverage and to improve the quality of care. The Small Business Health Options Program (SHOP) has room to improve the experience for small businesses. The interfaces between the county governments and Covered California must improve in order to ensure continuity of care as individuals move between Medi-Cal, Covered California, and employer-based coverage. And incentives between payors, plans, and providers need to be better aligned to ensure that quality care remains accessible for all Californians in the future.

Looking even further out, more work is necessary to finally guarantee universal coverage, both in California and in the nation as a whole. Neither Covered California nor Medi-Cal provides coverage to the 1.6 million uninsured undocumented immigrants living in California. Meanwhile, the petitioners in the pending King v. Burwell Supereme Court case seek to revoke tax subsidies that provide affordable care to 8.2 million people who live in states that do not operate their own health exchanges, such as Texas or Florida (but not California). If we are to attain universal coverage, policy makers will need to tackle these barriers to expanding care to all Americans, regardless of their state of residence or documentation status.

In conclusion, as we celebrate the successes of the past five years of reform and advancement in healthcare, we must remain diligent, identifying and developing creative new solutions to continued and emerging issues.

 

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