Oregon Health & Science University

Assess insurance Coverage Expansion on Diabetes complications

The ACA substantially increased access to health insurance and insurance coverage rates through Medicaid eligibility expansions (in states the expanded) and nationwide individual health insurance marketplaces. Analyses of the short-term impact of Medicaid expansion demonstrated increased access to preventative care and improved control of type 2 diabetes. However, there is limited information on the longer-term effects of Medicaid expansion of the health outcomes for patients who gain and lose Medicaid coverage due to changes in Medicaid eligibility. This study will analyze data from over 280,000 patients within the national ADVANCE clinical research network for community health centers, comparing outcomes for patients from states that expanded Medicaid with outcomes for patients from states that did not expand Medicaid, as well as examining patients with continuous insurance coverage, unstable insurance, and no insurance coverage. Outcomes will include acute and chronic diabetes-related complications as well as mortality. The analyses will also assess whether individual-level and/or community-level social determinants of health moderate the relationship between Medicaid expansion and health outcomes.