Changes in Health Insurance Coverage Under the Affordable Care Act: A National Sample of U.S. Adults With Diabetes, 2009 and 2016

Diabetes Care. 2018 May;41(5):956-962. doi: 10.2337/dc17-2524. Epub 2018 Feb 23.

Abstract

Objective: To assess national changes in health insurance coverage and related costs before and after implementation of the Affordable Care Act (ACA) among U.S. adults with diabetes.

Research design and methods: Data were cross-sectional from the 2009 and 2016 National Health Interview Surveys (NHIS). Participants were adults age ≥18 years with a previous diagnosis of diabetes who self-reported on their health insurance coverage, demographic information, diabetes-related factors, and amount spent on medical expenses and insurance premiums (N = 6,220).

Results: Among adults with diabetes age 18-64 years, health insurance coverage increased from 84.7% in 2009 to 90.1% in 2016 (P < 0.001). Coverage remained near universal for those age ≥65 years (99.5%). For adults age 18-64 years, coverage increased for almost all subgroups and significantly for men; non-Hispanic whites, non-Hispanic blacks, and Hispanics; those who were married; those with less than or more than a high school education, family income <$35,000, or diabetes duration <5 or >15 years; and those taking oral agents (P < 0.05 for all). Among adults age 18-64 years, Medicaid coverage significantly increased between 2009 and 2016 (19.4% vs. 24.3%, P = 0.006), and for those with private insurance, 7.8% acquired their plan through HealthCare.gov. For adults age ≥65 years, private insurance decreased and Medicare Part D increased (P < 0.007 for both). Among those age 18-64 years with an income <$35,000, the proportion of income spent on family medical costs decreased (6.3% vs. 4.8% for 2009 vs. 2016, respectively; P = 0.004).

Conclusions: Health insurance coverage among adults with diabetes age 18-64 years increased significantly after implementation of the ACA, and medical costs to families decreased among those with lower incomes.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cross-Sectional Studies
  • Diabetes Mellitus / economics*
  • Diabetes Mellitus / epidemiology*
  • Diabetes Mellitus / therapy
  • Ethnic Groups / statistics & numerical data
  • Female
  • Humans
  • Income / statistics & numerical data
  • Insurance Coverage / economics*
  • Insurance Coverage / trends
  • Insurance, Health / economics
  • Insurance, Health / statistics & numerical data
  • Insurance, Health / trends
  • Male
  • Medicaid / economics
  • Medicaid / statistics & numerical data
  • Medicaid / trends
  • Middle Aged
  • Patient Protection and Affordable Care Act* / economics
  • Poverty / economics
  • Poverty / statistics & numerical data
  • United States / epidemiology
  • Young Adult