Abstract
INTRODUCTION: Lack of health insurance is a barrier to medical care, which may increase the risk of diabetes complications and costs. The objective of this study was to assess the potential of the Affordable Care Act (ACA) of 2010 to improve diabetes care through increased health care access by comparing health care and health outcomes of insured and uninsured people with diabetes. METHODS: We examined demographics, access to care, health care use, and health care expenditures of adults aged 19 to 64 years with diabetes by using the 2011 and 2012 Medical Expenditure Panel Survey. Bivariate descriptive statistics comparing insured and uninsured persons were evaluated separately by income above and below 138% of the federal poverty level (FPL), (a threshold for expanded Medicaid eligibility in select states under the ACA) using the t test and proportion and median tests. RESULTS: Uninsured adults reported poorer access to care than insured adults, such as having a usual source of health care (69.0% vs 89.5% [≤138% FPL], 77.1% vs 94.6% [>138% FPL], both P < .001) and having lower rates of 6 key diabetes preventive care services (P ≤ .05). Insured adults with diabetes had significantly higher health care expenditures than uninsured adults ($13,706 vs $4,367, $10,838 vs $4,419, respectively, both P < .001). CONCLUSION: Uninsured adults with diabetes had less access to health care and lower levels of preventive care, health care use, and expenditures than insured adults. To the extent that the ACA increases access and coverage, uninsured people with diabetes are likely to significantly increase their health care use, which may lead to reduced incidence of diabetes complications and improved health.