RT Journal Article
SR Electronic
T1 Insurance Instability Among Community-Based Health Center Patients with Diabetes Post-Affordable Care Act Medicaid Expansion
JF The Journal of the American Board of Family
                Medicine
JO J Am Board Fam Med
FD American Board of Family Medicine
SP jabfm.2024.240186R1
DO 10.3122/jabfm.2024.240186R1
A1 Lester, Leo
A1 Dinh, Dang
A1 Larson, Annie E.
A1 Suchocki, Andrew
A1 Marino, Miguel
A1 DeVoe, Jennifer
A1 Huguet, Nathalie
YR 2025
UL http://www.jabfm.org/content/early/2025/03/28/jabfm.2024.240186R1.abstract
AB Background: To evaluate insurance instability (churn) among adults with diabetes receiving care at community-based health centers (CHCs).Methods: Retrospective cohort study using patients’ electronic health records data for 300,158 adults aged 19 to 64 with ≥3 ambulatory visits between 2014 and 2019 of which 39,542 churned out of insurance. Generalized estimating equation-based (GEE) logistic regression models were fitted to assess the odds of churning.Results: Among CHC patients, those with diabetes had 1.25 greater odds of churning than those without diabetes (aOR = 1.25; 95%CI = 1.18, 1.33). Among CHC patients with diabetes, the odds of churning were higher for those with uncontrolled diabetes, more complex medication regimens, and acute diabetes complication.Conclusions: CHC patients with diabetes are more likely to experience insurance instability than those without diabetes. Outreach efforts to reduce the impact of the postpandemic Medicaid disenrollment among patients with diabetes and lower income will be critical to reduce harmful health consequences.