Disparities in Biomarkers for Patients With Diabetes After the Affordable Care Act

Abstract

Background: Racial and ethnic minorities are disproportionately affected by diabetes and at greater risk of experiencing poor diabetes-related outcomes compared with non-Hispanic whites. The Affordable Care Act (ACA) was implemented to increase health insurance coverage and reduce health disparities. Objective: Assess changes in diabetes-associated biomarkers [hemoglobin A1c (HbA1c) and low-density lipoprotein] 24 months pre-ACA to 24 months post-ACA Medicaid expansion by race/ethnicity and insurance group. Research Design: Retrospective cohort study of community health center (CHC) patients. Subjects: Patients aged 19–64 with diabetes living in 1 of 10 Medicaid expansion states with ≥1 CHC visit and ≥1 HbA1c measurement in both the pre-ACA and the post-ACA time periods (N=13,342). Methods: Linear mixed effects and Cox regression modeled outcome measures. Results: Overall, 33.5% of patients were non-Hispanic white, 51.2% Hispanic, and 15.3% non-Hispanic black. Newly insured Hispanics and non-Hispanic whites post-ACA exhibited modest reductions in HbA1c levels, similar benefit was not observed among non-Hispanic black patients. The largest reduction was among newly insured Hispanics versus newly insured non-Hispanic whites (P<0.05). For the subset of patients who had uncontrolled HbA1c (HbA1c≥9%) within 3 months of the ACA Medicaid expansion, non-Hispanic black patients who were newly insured gained the highest rate of controlled HbA1c (hazard ratio=2.27; 95% confidence interval, 1.10–4.66) relative to the continuously insured group. Conclusions: The impact of the ACA Medicaid expansion on health disparities is multifaceted and may differ across racial/ethnic groups. This study highlights the importance of CHCs for the health of minority populations.

Differences in up-to-date colorectal and cervical cancer screening rates by ethnicity and preferred language: An analysis across patient-, clinic-, and area-level data sources

“…When these barriers to access are diminished, evidence suggests Hispanic patients may experience greater improvement in health outcomes relative to non-Hispanic whites ( Marino et al, 2020 ). The fact that racial and ethnic health disparities appear to be attenuated in CHCs compared to other healthcare settings ( Appel et al, 2006 ; Heintzman, Bailey, DeVoe, et al, 2017 ; Heintzman, Bailey, Muench, et al, 2017 ; Heintzman et al, 2018 ) underscores the importance of understanding the strategies CHCs have developed to deliver equitable care.…”

The Impact of the Affordable Care Act Medicaid Expansion on Acute Diabetes Complications Among Community Health Center Patients

“…These findings highlight the quality of care CHCs provide regardless of expansion status. Notably, previous studies have shown that gaining insurance in states that expanded Medicaid was associated with increase diabetes control, 29 especially among patients of Hispanic ethnicity receiving care in CHCs. Future studies are needed to assess whether the findings observed here differ by population subgroups.…”

Patients’ Perspective About the Cost of Diabetes Management: An Analysis of Online Health Communities

“…Though the Affordable Care Act provisions increased insurance coverage, the findings continue to be relevant due to the persistence of racial and socioeconomic disparities. 23 , 24 Further, self-selection bias may contribute to a limited set of experiences or perspectives since online participation is voluntary. Individuals may be uncomfortable sharing private information, even if anonymous.…”