IMPORTANCE Treatment advances in diabetes can meaningfully improve outcomes only if they effectively reach the populations at risk. OBJECTIVES To evaluate whether the cascade of US diabetes care, defined as diabetes diagnosis, linkage to care, and achievement of individual and combined treatment targets, improved from 2005 to 2016 and to investigate potential disparities in US diabetes care. DESIGN, SETTING, AND PARTICIPANTS Nationally representative, serial cross-sectional studies included in the 2005-2016 National Health and Nutrition Examination Survey were evaluated. Data on nonpregnant US adults (age Ն18 years) with diabetes who had reported fasting for 9 or more hours (n = 1742 diagnosed and 746 undiagnosed) were included. Data analysis was performed from August 1, 2018, to May 10, 2019.

ImportanceAdvance Child Tax Credit (CTC) monthly payments administered to more than 35 million households with children in the US between July and December 2021 were associated with a substantial decrease in food insufficiency. These monthly payments expired in January 2022 after Congress failed to extend the policy, and the subsequent impact on food insufficiency is currently unknown.ObjectiveTo assess whether the expiration of monthly CTC payments in January 2022 was associated with changes in food insufficiency in US households with children.Design, Setting, and ParticipantsThis study used repeated cross-sectional, nationally representative data from multiple waves of the Household Pulse Survey, conducted by the US Census Bureau. Online data collection occurred from July 21, 2021, to July 11, 2022, and data analysis was performed in July 2022.ExposuresThe first missed advance CTC payment on January 15, 2022.Main Outcomes and MeasuresThe main outcome was unadjusted prevalence of household food insufficiency. Event study specification was used to estimate the association between the expiration of the CTC payments and household food insufficiency with the exposure of being in a household with children present.ResultsThe sample (592 044 respondents, representing households with and without children, for a weighted population size of 123 350 770 individuals) was majority female (362 286 individuals [51.3%]) and non-Hispanic White (425 497 individuals [62.2%]), and a plurality of respondents (248 828 [48.3%]) were aged 25 to 44 years at the time of the survey. During the survey wave just before CTC expiration (reference wave, December 29, 2021, to January 10, 2022), unadjusted household food insufficiency was 12.7% among households with children. In late January and early February 2022, following the first missed CTC monthly payment, 13.6% of households with children reported food insufficiency, increasing to 16.0% by late June and early July 2022. The event study specification estimated a 3.2 percentage point increase (95% CI, 1.4-5.0 percentage points; P < .001) in food insufficiency by the most recent wave available after the first missed CTC payment (June 29 to July 11, 2022) among households with children compared with the reference wave, a 25% increase.Conclusions and RelevanceThe findings of this study suggest that there was an increase in food insufficiency among households with children after they stopped receiving monthly CTC payments. Given the well-documented associations between inability to afford food and poor health outcomes across the life span, Congress should consider swift action to reinstate this policy.

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In this issue of JAMA Internal Medicine, Feldman and colleagues 1 report that Medicare spending on insulin for patients with diabetes was an estimated $7.8 billion, which is $4.4 billion more than the Centers for Medicare & Medicaid Services might have spent by using the prices negotiated by the US Department of Veterans Affairs and their formulary restrictions. Even if the $4.4 billion figure overestimates the potential savings, the potential for lower prices would substantially increase many patients' access to life-saving insulin products. The report by Feldman et al 1 is one of several studies that JAMA Internal Medicine has recently published illustrating the opportunities for savings of billions of dollars annually in the Medicare Part D prescription drug program. For the top 50 oral drugs dispensed based on Medicare spending, Venker et al 2 estimated that by using US Department of Veterans Affairs medication prices, Medicare could have saved up to $14.4 billion in 2016 of the estimated $32.5 billion spent. For angiotensin-converting enzyme inhibitors and angiotensin-II-receptor blockers alone, Growdon et al 3 estimated potential Medicare savings in 2016 and 2017 at $676 million of the total $754 million spent by using generic substitution and therapeutic interchange. For inhaler prescriptions, Feldman et al 4 previously estimated potential Medicare savings in 2017 of up to $4.2 billion of the $7.3 billion spent through use of negotiated prices and a defined formulary. These studies have a consistent and clear message. At present, the issue for the federal government is not the ability to easily save billions of dollars each year in Medicare Part D spending. Rather, the issue is the political will in Washington, DC, to facilitate savings through legislation and regulatory changes, such as measures that would allow price negotiations, benchmark pricing, and formulary restrictions, and in states to remove prescribing barriers, such as those for generic substitution and therapeutic interchange.

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