Medicaid expansion under health reform may increase service use and improve access for low-income adults with diabetes

Health Affairs

Volumn 31, Issue 1, 2012, Pages 159-167

  Garfield, Rachel L ^a   Damico, Anthony ^b  

^a Kaiser Commission on Medicaid and the Uninsured   (United States)

^b HENRY J KAISER FAMILY FOUNDATION   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ADULT; ARTICLE; CONTROLLED STUDY; DIABETES MELLITUS; HEALTH CARE ACCESS; HEALTH CARE COST; HEALTH CARE DELIVERY; HEALTH CARE POLICY; HEALTH CARE UTILIZATION; HEALTH SERVICE; HUMAN; LOWEST INCOME GROUP; MEDICAID; PEER GROUP; SAMPLE SIZE;

ADOLESCENT; ADULT; DIABETES MELLITUS; FEMALE; HEALTH CARE SURVEYS; HEALTH SERVICES ACCESSIBILITY; HUMANS; MEDICAID; MIDDLE AGED; PATIENT PROTECTION AND AFFORDABLE CARE ACT; POVERTY; UNITED STATES; YOUNG ADULT;

EID: 84855677791     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.2011.0903     Document Type: Article

References (29)

1. Harris MI. Racial and ethnic differences in health insurance coverage for adults with diabetes. Diabetes Care. 1999;22(10):1679-82.
2. Gilmer T. Costs of chronic disease management for newly insured adults. Med Care. 2011;49(9):e22-7.
3. Kaiser Commission on Medicaid and the Uninsured. The Medicaid program at a glance [Internet]. Washington (DC): The Commission; 2010 Jun [cited 2011 Nov 10]. (Medicaid Facts). Available from: http:// www.kff.org/medicaid/upload/ 7235-04.pdf
4. The Affordable Care Act sets Medicaid income eligibility at 133 percent of poverty, with an additional 5 percent income disregard, bringing the effective eligibility level to 138 percent
5. Kaiser Family Foundation. Medicaid and Children's Health Insurance Program provisions in the new health reform law [Internet]. Menlo Park (CA): KFF; 2010 Apr 7 [cited 2011 Nov 10]. (Focus on Health Reform). Available from: http:// www.kff.org/healthreform/upload/ 7952-03.pdf
6. Guyer J, Paradise J. Explaining health reform: benefits and costsharing for adult Medicaid beneficiaries [Internet]. Menlo Park (CA): Kaiser Family Foundation; 2010 Aug [cited 2011 Nov 10]. (Focus on Health Reform). Available from: http://www.kff.org/healthreform/ upload/8092.pdf
7. Centers for Disease Control and Prevention. National diabetes fact sheet 2011: national estimates and general information on diabetes and prediabetes in the United States [Internet]. Atlanta (GA): CDC; 2011 [cited 2011 Dec 19]. Available from: http://www.cdc.gov/diabetes/pubs/ pdf/ndfs_2011.pdf
8. Brown AF, Ettner SL, Piette J, Weinberger M, Gregg E, Shapiro MF, et al. Socioeconomic position and health among persons with diabetes mellitus: a conceptual framework and review of the literature. Epidemiol Rev. 2004;26:63-77.
9. Cohen M. (Urban Institute; Washington, DC). An overview of Medicaid enrollees with diabetes in 2003 [Internet]. Washington (DC): Kaiser Commission on Medicaid and the Uninsured; 2007 Oct [cited 2011 Nov 10]. (Issue Paper). Available from: http://www.kff.org/medicaid/ upload/7700.pdf
10. We pooled years to capture a larger sample size and increase the power of our analysis. A comparison of outcomes between the 2007 and 2008 survey files yielded no significant differences, indicating no loss of information due to a pooled sample.
11. We excluded those with coverage changes throughout the year to match the timing of insurance and access measures, which ask about all access and use over the past year
12. We present total use (rather than just diabetes-related use) for several reasons. First, this measure corresponds to the total health expenditure data presented elsewhere. Second, given high rates of comorbidity among people with diabetes, this measure provides a fuller picture of use for this population. Third, for some services, we were unable to differentiate between diabetes- and non-diabetes-related services. Last, because most use-even among people with diabetes-is for nondiabetes-related care, many sample sizes for diabetes-related use for specific service types were too small to allow reliable estimates.
13. This subset included inpatient, outpatient, emergency department, office-based, and home health care
14. Coffey RM, Matthews TL, McDermott K. Diabetes care quality improvement: a resource guide for state action [Internet]. Rockville (MD): Agency for Healthcare Research and Quality; 2004 Sep [cited 2011 Nov 10]. (AHRQ Pub. No. 04-0072). Available from: http:// www.ahrq.gov/qual/diabqual/ diabqguide.htm
15. Wilper AP, Woolhandler S, Lasser KE, McCormick D, Bor DH, Himmelstein DU. Hypertension, diabetes, and elevated cholesterol among insured and uninsured US adults. Health Aff (Millwood). 2009;28(6):w1151-9. DOI: 10.1377/ hlthaff.28.6.w1151.
16. Sing M, Banthin JS, Selden TM, Cowan CA, Keehan SP. Reconciling medical expenditure estimates from the MEPS and NHEA, 2002. Health Care Financ Rev. 2006;28(1):25-40.
17. To access the Appendix, click on the Appendix link in the box to the right of the article online
18. DeVoe JE, Tillotson CJ, Wallace LS. Usual source of care as a health insurance substitute for U.S. adults with diabetes? Diabetes Care. 2009; 32(6):983-9.
19. According to the authors' analysis, there were 1.1 million uninsured nonelderly adults with diabetes living in families below 138 percent of the federal poverty level in December 2008.
20. Piette JD, Kerr EA. The impact of comorbid chronic conditions on diabetes care. Diabetes Care. 2006;29(3):725-31.
21. Peele PB, Lave JR, Songer TJ. Diabetes in employer-sponsored health insurance. Diabetes Care. 2002; 25(11):1964-8.
22. Piette JD, Wagner TH, Potter MB, Schillinger D. Health insurance status, cost-related medication underuse, and outcomes among diabetic patients in three systems of care. Med Care. 2004;42(2):102-9.
23. Zhang JX, Huang ES, Drum ML, Kirchoff AC, Schlichting JA, Schaefer CT, et al. Insurance status and quality of diabetes care in community health centers. Am J Public Health. 2009;99(4):742-7.
24. Nelson KM, Chapko MK, Reiber G, Boyko EJ. The association between health insurance coverage and diabetes care; data from the 2000 Behavioral Risk Factor Surveillance System. Health Serv Res. 2005; 40(2):361-72.
25. Amundson GM, O'Connor PJ, Solberg LI, Asche SE, Woods RC, Parker ED, et al. Diabetes care quality: insurance, health plan, and physician group contributions. Am J Manag Care. 2009;15(9):585-92.
26. Nichol MB, Knight TK, Priest JL, Wu J, Cantrell CR. Nonadherence to clinical practice guidelines and medications for multiple chronic conditions in a California Medicaid population. J Am Pharm Assoc (2003). 2010;50(4):496-507.
27. Priest JL, Cantrell CR, Fincham J, Cook CL, Burch SP. Quality of care associated with common chronic diseases in a 9-state Medicaid population utilizing claims data: an evaluation of medication and health care use and costs. Popul Health Manag. 2011;14(1):43-54.
28. Garis RI, Farmer KC. Examining costs of chronic conditions in a Medicaid population. Manag Care. 2002;11(8):43-50.
29. Kahn R, Anderson JE. Improving diabetes care: the model for health care reform. Diabetes Care. 2009; 32(6):1115-8.