Med Care

BackgroundRacial 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.ObjectiveAssess changes in diabetes-associated biomarkers [hemoglobin Alc (HbAlc) and low-density lipoprotein] 24 months pre-ACA to 24 months post-ACA Medicaid expansion by race/ethnicity and insurance group.Research DesignRetrospective cohort study of community health center (CHC) patients.SubjectsPatients aged 19\u201364 with diabetes living in 1 of 10 Medicaid expansion states with 65 1 CHC visit and 65 1 HbAlc measurement in both the pre-ACA and the post-ACA time periods (N = 13,342).MethodsLinear mixed effects and Cox regression modeled outcome measures.ResultsOverall, 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 HbAlc 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 HbAlc (HbAlc 65 9%) within 3 months of the ACA Medicaid expansion, non-Hispanic black patients who were newly insured gained the highest rate of controlled HbAlc (hazard ratio = 2.21: 95% confidence interval, 1.10\u20144.66) relative to the continuously insured group.ConclusionsThe 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.20202021-06-01T00:00:00ZR01 HL136575/HL/NHLBI NIH HHS/United StatesU18 DP006116/DP/NCCDPHP CDC HHS/United StatesU18DP006116/ACL/ACL HHS/United States32412951PMC7365657799