Patient Information | Nonexpansion | Expansion | Expansion vs Nonexpansion |
---|---|---|---|
Post-ACA vs Pre-ACA | Post-ACA vs Pre-ACA | ||
RR (95% CI) | RR (95% CI) | DD Ratio (95% CI) | |
Uninsured | |||
Diabetes | 0.85 (0.76–0.94) | 0.44 (0.39–0.49) | 0.52 (0.44–0.60) |
Prediabetes | 0.86 (0.76–0.95) | 0.48 (0.42–0.54) | 0.56 (0.47–0.65) |
No diabetes | 0.82 (0.74–0.89) | 0.47 (0.42–0.52) | 0.57 (0.50–0.65) |
Medicaid | |||
Diabetes | 0.99 (0.92–1.07) | 1.57 (1.43–1.71) | 1.58 (1.40–1.77) |
Prediabetes | 1.07 (0.98–1.16) | 1.71 (1.53–1.88) | 1.59 (1.38–1.80) |
No diabetes | 1.00 (0.91–1.09) | 1.60 (1.46–1.73) | 1.60 (1.40–1.80) |
Privately insured | |||
Diabetes | 2.77 (1.79–3.75) | 1.10 (0.96–1.25) | 0.40 (0.25–0.55) |
Prediabetes | 3.17 (2.03–4.31) | 1.10 (0.90–1.31) | 0.35 (0.21–0.49) |
No diabetes | 2.70 (2.02–3.38) | 1.06 (0.94–1.18) | 0.39 (0.28–0.50) |
Other public | |||
Diabetes | 0.79 (0.66–0.92) | 1.08 (0.97–1.20) | 1.37 (1.10–1.64) |
Prediabetes | 0.84 (0.65–1.03) | 1.04 (0.86–1.22) | 1.24 (0.89–1.59) |
No diabetes | 0.73 (0.59–0.87) | 0.90 (0.77–1.04) | 1.24 (0.94–1.53) |
Total visit | |||
Diabetes | 1.00 (0.93–1.07) | 1.05 (0.99–1.09) | 1.04 (0.95–1.14) |
Prediabetes | 1.10 (1.00–1.19) | 1.15 (1.09–1.20) | 1.05 (0.94–1.16) |
No diabetes | 0.98 (0.91–1.06) | 1.03 (0.98–1.08) | 1.05 (0.95–1.15) |
Primary care | |||
Diabetes | 0.98 (0.91–1.06) | 1.03 (0.98–1.07) | 1.05 (0.96–1.14) |
Prediabetes | 1.08 (0.98–1.17) | 1.14 (1.08–1.19) | 1.05 (0.95–1.16) |
No diabetes | 0.96 (0.88–1.04) | 1.02 (0.96–1.07) | 1.06 (0.95–1.16) |
Preventive Care | |||
Diabetes | 1.26 (1.03–1.50) | 1.12 (1.02–1.23) | 0.89 (0.71–1.08) |
Prediabetes | 1.35 (1.13–1.58) | 1.31 (1.19–1.42) | 0.96 (0.79–1.14) |
No diabetes | 1.20 (1.04–1.37) | 1.11 (1.01–1.20) | 0.92 (0.77–1.07) |
Glucose testing | |||
Diabetes | 1.22 (1.11–1.32) | 1.14 (1.09–1.20) | 0.94 (0.84–1.04) |
Prediabetes | 1.24 (1.13–1.35) | 1.23 (1.17–1.30) | 0.99 (0.89–1.09) |
No diabetes | 1.20 (1.09–1.31) | 1.29 (1.21–1.37) | 1.07 (0.95–1.19) |
HbA1c screening | |||
Diabetes | 1.46 (1.35–1.56) | 1.26 (1.21–1.31) | 0.87 (0.80–0.94) |
Prediabetes | 1.76 (1.56–1.95) | 2.00 (1.80–2.19) | 1.14 (0.87–1.40) |
No diabetes | 1.70 (1.45–1.96) | 2.26 (1.97–2.56) | 1.33 (1.09–1.57) |
ACA, Affordable Care Act; RR, rate ratio; CI, confidential interval; DD, difference-in-difference testing post-period versus pre-period in expansion versus non-expansion states.
↵* Nonexpansion states: FL, KS, MO, and NC; expansion states: CA, HI, MD, NM, OH, OR, RI, WA, and WI. Visit rates were by dividing the number of visits in a given interval (ie, pre-ACA or post-ACA period) by the total number of adult patients seen in a clinic over the study period, scaled to 1000 patients per month. Boldfaced values indicate statistically significant difference, P < .05. Total visits: CPT 99201 to 99205, 99212 to 99215, 99241 to 99245, 99381 to 99384, 99385 to 99387, or 99391 to 99397 with MD, DO, NP, PA, midwife, or resident with no specialty listed. Generalized estimating equation Poisson models adjusted for clinic-level demographic distributions (sex, age, federal poverty level, primary language, race, and ethnicity), state-level factors (marketplace type, 2013 minimum wage and unemployment rates, 2013 uninsured rate), and 2013 state-level CHCs diabetes prevalence (https://bphc.hrsa.gov/datareporting/index.html) clustered by facility to account for within-facility correlation. DD estimates obtained from linear combinations of time × expansion status interaction.