1235-P: Effects of Medicaid Expansion on Uninsured Rates: Diabetes Belt vs. Non-Belt Counties

Abstract

Objective: To examine trends in insurance rates in 2012-2016 among low-income adults aged <65 and determine whether Medicaid expansion helped reduce the gap in uninsured rates between Diabetes Belt (DB) and non-DB counties. The Diabetes Belt is a region with elevated rates of diabetes that includes 644 counties across 15 southeastern states. Methods: Data for 1,180 county-level data from the Small Area Health Insurance Estimates and Area Health Resources File were used to analyze the trends in uninsured rates in populations with household income ≤138% federal poverty line (FPL). Multivariable analysis adjusted for county percent population aged 50-64 years, females, married, distress county index, and rurality. Results: Crude uninsured rates were 5% higher in DB compared to non-DB counties (39% vs. 34%, p < 0.001) in 2012. Uninsured rates declined rapidly in both DB and non-DB counties to 13% and 15% in 2016. Adjusted changes in uninsured rates between 2012 and 2016 were 31% in DB (p < 0.001) and 21% in non-DB counties (p < 0.001) with the adjusted uninsured rates being 16% in both areas in 2016. Figure below shows the trends. Discussion: Medicaid expansion had the intended effects on reducing uninsured rates in both DB and non-DB counties. Initial disparities in uninsured rates between the two areas were completely eradicated by 2016. Medicaid expansion may have helped improve uptake of preventive care in the Diabetes Belt. Disclosure J.M. Lobo: None. S. Kim: None. G.M. Ocker: None. H. Kang: None. T.L. McMurry: None. M. Sohn: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R01DK113295)