Much of the debate surrounding the Affordable Care Act (“Obamacare”), the federal law passed by Congress and signed by President Obama in 2010, has been about dollars and cents: who’s paying how much for health care, and how much the federal government financially supports people who might not otherwise be able to afford insurance. It has also reached into the territory of morality, such as whether it should be acceptable to charge people with preexisting medical conditions more for insurance, or whether the federal government should be able to force people to buy insurance. But one critical topic has been mostly missing from the discussion: whether the law will make anyone healthier or get better access to treatments.
It might sound like common sense that expanding health insurance coverage would result in more people getting treatment and being healthy, but not everyone has been in agreement on this issue. Some, such as conservative columnist Ross Douthat of The New York Times, have argued that while expanded coverage results in more doctor visits and treatments, this extra health-care consumption has almost no impact on rates of common conditions such as diabetes and hypertension (high blood pressure). Some moderates and liberals, in turn, have argued that many of the poor already get free treatments in emergency rooms that are costly to taxpayers — and so expanding health insurance coverage so that problems are treated in regular doctors’ offices could save money, even if it doesn’t expand the scope of medical treatment. It turns out that according to a new study, both of these positions are wrong.
The study, published late last month in the journal Diabetes Care, compared states that expanded their Medicaid programs under the Affordable Care Act with those that did not. (Medicaid is a jointly funded federal–state health insurance program for low-income people.) While Medicaid expansion was supposed to be mandatory for every state under the law — with the federal government paying for 100% of the cost of this expanded coverage for three years, then 90% of the cost after that — the U.S. Supreme Court struck down this provision and made the expansion optional for each state. At the time the study was conducted last year, 26 states and the District of Columbia had expanded their Medicaid programs. Since then, two more states have done so.
The most striking finding was that compared with the first six months of 2013 — when no states had expanded Medicaid — during the first six months of 2014, states that expanded Medicaid saw a 23% jump in newly diagnosed cases of diabetes among Medicaid participants. (The study didn’t distinguish between Type 1 and Type 2 diabetes.) States that didn’t expand Medicaid saw only a 0.4% increase in diabetes diagnoses, meaning that virtually 100% of the surge in diabetes detection in the other states was due to the expanded health coverage. As noted in a U.S. News & World Report article on the study, researchers also looked at test results and medical data related to people with newly diagnosed diabetes. They found not only that there were more cases of diabetes detected in Medicaid-expansion states, but that diabetes tended to be found in its earlier stages in these states, as well. This is a significant finding, since diabetes is less likely to result in damaging and expensive complications such as neuropathy (nerve damage), nephropathy (kidney disease), and foot ulcers — which can lead to amputations — if the condition is detected at an early stage.
Does this study change your view of the Affordable Care Act, or of Medicaid and whether states choose to expand this program? Is detecting diabetes enough of a reason to expand health insurance coverage, or should coverage only be expanded if it saves money in the long run by reducing diabetic complications and the cost of treating them? Do you know anyone who has gotten health insurance — or a diabetes diagnosis — as a result of Medicaid expansion? Since virtually every American over 65 gets taxpayer-funded treatment through Medicare, should the government try to reduce these costs by helping people detect and treat diseases at a younger age, when the diseases may be more manageable? Leave a comment below!
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