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Trends in Uninsured Rates Before and After Medicaid Expansion in Counties Within and Outside of the Diabetes Belt
- Source :
- Diabetes Care
- Publication Year :
- 2020
- Publisher :
- American Diabetes Association, 2020.
-
Abstract
- OBJECTIVE To examine trends in uninsured rates between 2012 and 2016 among low-income adults aged RESEARCH DESIGN AND METHODS Data for 3,129 U.S. counties, obtained from the Small Area Health Insurance Estimates and Area Health Resources Files, were used to analyze trends in uninsured rates among populations with a household income ≤138% of the federal poverty level. Multivariable analysis adjusted for the percentage of county populations aged 50–64 years, the percentage of women, Distressed Communities Index value, and rurality. RESULTS In 2012, 39% of the population in the Diabetes Belt and 34% in non-Belt counties were uninsured (P < 0.001). In 2016 in states where Medicaid was expanded, uninsured rates declined rapidly to 13% in Diabetes Belt counties and to 15% in non-Belt counties. Adjusting for county demographic and economic factors, Medicaid expansion helped reduce uninsured rates by 12.3% in Diabetes Belt counties and by 4.9% in non-Belt counties. In 2016, uninsured rates were 15% higher for both Diabetes Belt and non-Belt counties in the nonexpansion states than in the expansion states. CONCLUSIONS ACA-driven Medicaid expansion was more significantly associated with reduced uninsured rates in Diabetes Belt than in non-Belt counties. Initial disparities in uninsured rates between Diabetes Belt and non-Belt counties have not existed since 2014 among expansion states. Future studies should examine whether and how Medicaid expansion may have contributed to an increase in the use of health services in order to prevent and treat diabetes in the Diabetes Belt.
- Subjects :
- Adult
Male
Research design
Endocrinology, Diabetes and Metabolism
Population
030209 endocrinology & metabolism
Health Services Accessibility
Insurance Coverage
Young Adult
03 medical and health sciences
Health services
0302 clinical medicine
Rurality
Diabetes mellitus
parasitic diseases
Diabetes Mellitus
Internal Medicine
medicine
Humans
030212 general & internal medicine
Epidemiology/Health Services Research
education
Poverty
Aged
Advanced and Specialized Nursing
Medically Uninsured
education.field_of_study
Insurance, Health
Local Government
Geography
Medicaid
business.industry
Patient Protection and Affordable Care Act
technology, industry, and agriculture
Middle Aged
equipment and supplies
medicine.disease
United States
Socioeconomic Factors
Household income
Female
business
human activities
Demography
Subjects
Details
- ISSN :
- 19355548 and 01495992
- Volume :
- 43
- Database :
- OpenAIRE
- Journal :
- Diabetes Care
- Accession number :
- edsair.doi.dedup.....a1e871057ca8c7500b52c8e05cad43e3