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Association of the Affordable Care Act Medicaid Expansion with Dilated Eye Examinations among the United States Population with Diabetes.
- Source :
-
Ophthalmology [Ophthalmology] 2020 Jul; Vol. 127 (7), pp. 920-928. Date of Electronic Publication: 2019 Sep 17. - Publication Year :
- 2020
-
Abstract
- Purpose: To evaluate the association between Medicaid expansion and diabetic dilated eye examinations.<br />Design: A retrospective difference in differences (DiD) analysis using individual-level survey response data from January 1, 2009, to December 31, 2017.<br />Participants: A total of 52 392 survey responses from 50 states and the District of Columbia between 2009 and 2017. Responders were adults aged 18 to 64 years reporting a previous diagnosis of diabetes and a household income below 138% of the US federal poverty line (FPL).<br />Methods: The Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System data were used to identify survey responders who were asked about the presence of dilated eye examinations from years before and after Medicaid expansion implementation.<br />Main Outcome Measures: The DiD in proportion of dilated eye examinations among diabetic persons aged 18 to 64 years with household incomes below 138% of the FPL between states that did and did not implement Medicaid expansion.<br />Results: Implementation of Medicaid expansion policies was associated with a 1.3% (95% confidence interval [CI], -3.8 to 6.4; P = 0.61), 6.3% (95% CI, 1.3-11.3; P = 0.016), 4.1% (95% CI, -0.8 to 9.0; P = 0.11), and 2.3% (95% CI, -1.6 to 6.2; P = 0.23) increase in the proportion of diabetic persons aged 18 to 64 years with incomes below 138% of the FPL receiving a dilated eye examination within the past year due to Medicaid expansion 1, 2, 3, and 4 cumulative years after expansion, respectively.<br />Conclusions: Medicaid expansion policies were significantly associated with an increase in dilated eye examination rates within the first 2 years after implementation. However, this increase did not persist beyond this period, with nonsignificant increases 3 and 4 cumulative years after implementation. Healthcare policymakers should be aware that additional measures beyond expanding insurance coverage may be necessary to increase and sustain the rate of dilated eye examinations among diabetic populations.<br /> (Copyright © 2019 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Adolescent
Adult
Diabetes Mellitus diagnosis
Diabetes Mellitus epidemiology
Diabetic Retinopathy epidemiology
Female
Humans
Incidence
Male
Middle Aged
Retrospective Studies
United States epidemiology
Young Adult
Diabetic Retinopathy diagnosis
Health Services Accessibility statistics & numerical data
Insurance Coverage statistics & numerical data
Medicaid statistics & numerical data
Patient Protection and Affordable Care Act standards
Subjects
Details
- Language :
- English
- ISSN :
- 1549-4713
- Volume :
- 127
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- Ophthalmology
- Publication Type :
- Academic Journal
- Accession number :
- 31735405
- Full Text :
- https://doi.org/10.1016/j.ophtha.2019.09.010