What happens when you expand access to health care in America? More people with previously undiagnosed illnesses can get the diagnosis and treatment that they need.
It’s constitutional – deal with it
Putting off visits to the doctor because you don’t have insurance is common, says Dr. Vivian Fonseca, a professor of medicine and endocrinology at Tulane University, in New Orleans. And that’s particularly a problem for people with diabetes, he says.
“We’ve known for a long, long time that a lot of people with Type II diabetes go unrecognized for many years because they don’t get screened,” Fonseca says. And one of the main reasons they don’t get screened, he says, is that they don’t have health insurance.
Fonseca and his colleagues wondered whether Medicaid expansion under the Affordable Care Act, which became law five years ago Monday, has improved the detection of diabetes. That possibility seemed likely because more poor people now have insurance.
In 2012, the Supreme Court ruled that states could choose whether to expand their Medicaid programs under the ACA. In January 2014, about half the states, including Ohio, expanded and about half did not. This created what Fonseca calls a natural experiment — an opportunity to compare the impact of Medicaid programs on diabetes care.
Using data collected by the clinical laboratory Quest Diagnostics, Fonseca and his colleagues first looked at states that did not expand Medicaid. They saw a very small percentage increase (compared to the previous year) in diabetes diagnoses.
Then they looked at states that expanded Medicaid, and saw, among Medicaid patients, a much bigger increase — 23 percent. That translated into thousands of people with previously undiagnosed Type II diabetes being discovered because of Medicaid’s expansion, Fonseca says. He and his colleagues have published the study online this week in Diabetes Care, the journal of the American Diabetes Association.
Dr. Robert Ratner, the chief medical officer for the American Diabetes Association, says the study is important because early diagnosis and treatment are particularly crucial with diabetes. Left untreated, the disease can lead to blindness, heart attack, kidney failure or complications that require amputation of the foot or leg.
“Early and aggressive therapy of diabetes has a major impact on long-term complications and on quality of life,” Ratner says.
Early intervention may also reduce long-term costs, which account for a large percentage of overall health care spending.
But Ratner points out an irony of the study: Many of the states that did not expand Medicaid are in what he calls the “diabetes belt.” It’s a region stretching from Louisiana to North Carolina.
“Those states that did not expand Medicaid missed that opportunity and they still have large percentages of people, perhaps as high as 20 percent, living with diabetes who don’t know it,” he says.
The study is here. Not everyone buys into the conclusions – this NYT story quotes one skeptic of the result and one who cautioned that the cost effect of early diagnosis has not been established – but it’s easy enough to see how early diagnosis and treatment could have a large benefit for the people who receive it. In Texas, nearly ten percent of adults have been diagnosed with diabetes, with the prevalence among blacks and Hispanics being about double what it is for whites. I don’t know how many have it but don’t have not been diagnosed, but I’d guess it’s a lot. As you might imagine, folks who have diabetes but don’t have health insurance visit the emergency room a lot. And yet we’re supposed to believe that expanding Medicaid is something we can’t afford. It makes no sense at all. Daily Kos has more.