New diabetes cases in expanded-Medicaid states much higher than other states; 46,000 new Ky. Medicaid clients got screened

By Melissa Patrick
Kentucky Health News

New diabetes cases among poor Americans are much more numerous in Kentucky and other states that have embraced the Patient Protection and Affordable Care Act, a medical testing company has found. The diagnoses rose 23 percent in the Obamacare states and barely rose in the others, apparently because state Medicaid programs are encouraging screening for diabetes.

Quest Diagnostics conducted the study by analyzing laboratory test results from all 50 states and the District of Columbia in its large database over two six-month periods, Sabrina Tavernise reports for The New York Times. The authors determined that because in January 2014, 26 states and the District of Columbia had expanded Medicaid and 24 had not, it was a good time to conduct this study, which is reported in the journal Diabetes Care.

The research team used the results of the basic test for diabetes, which measures a form of hemoglobin that has interacted with glucose, A1c. “In the states that expanded Medicaid, the number of Medicaid enrollees with newly identified diabetes rose by 23 percent, to 18,020 in the first six months of 2014, from 14,625 in the same period in 2013,” Tavernise reports. “The diagnosis rose by only 0.4 percent — to 11,653 from 11,612 — in the states that did not expand Medicaid.”

A Kentucky study indicates that more screening isn’t the only reason for such numbers; the Medicaid expansion population appears to be more susceptible to diabetes than normal.

The study by Deloitte Consulting found that chronic conditions, including diabetes, were more than twice as prevalent in the expansion population than other people of the same age and gender who were on Medicaid before it expanded. That comparative group was considered to be the group most similar to the Medicaid expansion population, since the state lacks historical data for the expansion group.

The study found that the Medicaid expansion group had a 102.5 percent higher prevalence of diabetes than the comparative group. About two of every 1,000 in the expansion group had diabetes, compared to one of every 1,000 members of the traditional-Medicaid group.
About 46,000 of the 400,000 people in the expansion group had a diabetes screening in the first year of the expansion. Both studies suggest better access and utilization of preventive care and early diagnosis will promote earlier treatment and better long-term outcomes.
Kentucky ranks 17th among the states in prevalence of diabetes, according to the 2014 “States of Obesity” report.  The state Cabinet for Health and Family Services reports an estimated 233,000 adult Kentuckians have pre-diabetes. For county-by-county data on diabetes, click here.

Quest Diagnostics recognized that its study only looked at changes in raw numbers of the lab results from one company and did not have access to a federal data set. This has caused some to voice skepticism that the study results are a result of the Medicaid expansion. Others, while recognizing that the study did not “have the precision of a scientific drug trial,” Tavernise writes, said “the changes in the numbers are real … 23 percent versus zero,” and that “the health-care law was the most plausible explanation for the findings.” Another said, “for an observational study, it’s really very strong.”

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.
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