Nebraska’s LB 472, the Medicaid Redesign Act, would provide health insurance coverage through the state’s Medicaid program to those in the coverage gap. People fall into the gap when they make too much income to qualify for traditional Medicaid coverage but not enough to qualify for premium assistance tax credits through the health insurance marketplace, and they lack access to employer-provided insurance.
One clear advantage of health insurance is prevention. It allows individuals and families to get screenings and checkups to catch diseases and conditions early, before they become more serious and more expensive. Caught at the outset, a relatively simple and inexpensive regime of treatment will address most health conditions.
Recent research published by the American Diabetes Association finds how LB 472 will make this possible in Nebraska. Their findings showed that diagnoses of newly identified diabetes cases increased 23% in states that expanded their Medicaid program. States that did not (like Nebraska) had an increase of only 0.4%. That is over a 900% difference in diagnoses of a condition that is at epidemic levels in the United States and globally.
Dr. Vivian Fonseca, professor of medicine at Tulane University and a co-author of the study, said about the reason for the differences between the states, “I cannot think of any other explanation except these people have now got health insurance,” and are going to the doctor and getting tested.
As many of us know, the risks of undiagnosed and untreated diabetes are severe. Diabetics have a higher risk of heart disease, stroke, kidney failure, and blindness, and losing toes, feet, and legs to amputation. The risk of death for adults with diabetes is 50% higher than it is for nondiabetic adults, according to the Centers for Disease Control and Prevention.
More than 29 million Americans, over 9% of the population, have diabetes. About a quarter of them are not diagnosed. Another 86 million Americans have pre-diabetes, higher-than-normal blood sugar levels with an elevated risk of developing diabetes.
Diabetes is also enormously expensive to society and the health care system. Studies have shown that $1 in every $10 spent in the U.S. health care system was attributable to diabetes. At a time when the nation is exploring methods to modernize and reform the health care system, implementing a system to provide diagnosis of a growing disease that is relatively inexpensive to treat seems paramount.
The researchers also found that tests to identify diabetes generally found new diagnoses at lower levels in expansion states, suggesting those patients had their diabetes detected earlier and that those patients will experience better management of the disease. This will lead to better health outcomes and fewer long-term complications.
The findings regarding diabetes and the affect Medicaid expansion has on diagnosis and treatment are likely to affect the diagnosis of other chronic conditions such as hypertension, cholesterol, and chronic kidney disease.
Our analysis (see Health Care in Rural America) and other research has found more rural people have common diseases and conditions such as arthritis, asthma, heart disease, diabetes, hypertension, and mental disorders than urban residents. The Center on an Aging Society at Georgetown University in Washington DC summarizes the health status of the nation as this: “The rural population is consistently less well off than the urban population with respect to health.”
LB 472 will help low-income diabetics simply by finding them. “Early identification can be potentially life-saving for people with diabetes,” said Dr. Fonseca. Early diagnoses are also beneficial to society and state coffers. The prevention of diabetic complications have been shown to be “cost saving, since the complications – including blindness, amputations and kidney failure requiring dialysis or transplant – are extremely expensive,” states Dr. Fonseca.
And after diabetics are found, LB 472 will provide a method to treat and manage their disease. Without LB 472, many low-income diabetics, especially in rural areas, will not be found, will not be diagnosed, and will not be treated. And many of them will eventually die from an undiscovered, but treatable disease.
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