Disparities in Biomarkers for Patients With Diabetes After the Affordable Care Act : Medical Care

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Disparities in Biomarkers for Patients With Diabetes After the Affordable Care Act

Marino, Miguel PhD*,†; Angier, Heather PhD, MPH*; Fankhauser, Katie MPH*; Valenzuela, Steele MS*; Hoopes, Megan MPH; Heintzman, John MD, MPH*,‡; DeVoe, Jennifer MD, DPhil*,‡; Moreno, Laura MPH*; Huguet, Nathalie PhD*

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Medical Care 58():p S31-S39, June 2020. | DOI: 10.1097/MLR.0000000000001257



Racial 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.


Assess changes in diabetes-associated biomarkers [hemoglobin A1c (HbA1c) and low-density lipoprotein] 24 months pre-ACA to 24 months post-ACA Medicaid expansion by race/ethnicity and insurance group.

Research Design: 

Retrospective cohort study of community health center (CHC) patients.


Patients aged 19–64 with diabetes living in 1 of 10 Medicaid expansion states with ≥1 CHC visit and ≥1 HbA1c measurement in both the pre-ACA and the post-ACA time periods (N=13,342).


Linear mixed effects and Cox regression modeled outcome measures.


Overall, 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 HbA1c 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 HbA1c (HbA1c≥9%) within 3 months of the ACA Medicaid expansion, non-Hispanic black patients who were newly insured gained the highest rate of controlled HbA1c (hazard ratio=2.27; 95% confidence interval, 1.10–4.66) relative to the continuously insured group.


The 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.

Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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