Events

Diabetes and hypertension are top contributors to avoidable burden disease in the United States due to high prevalence and incomplete detection and treatment. The Affordable Care Act Medicaid expansions expanded insurance coverage in low-income adults, a group with higher risk of untreated conditions. This paper assesses whether Medicaid expansions after the Affordable Care Act were associated with increased initiation of pharmaceutical treatment for diabetes and hypertension by analyzing sales data, including over 1 billion new prescriptions in from 2006-2015 in all United States counties. We find that prior to the Affordable Care Act, trends in treatment initiation were not significantly different between states with vs. without subsequent Medicaid expansions. Affordable Care Act Medicaid expansions were associated with significantly increased initiation of diabetes and hypertension treatment paid for with Medicaid insurance for both men and women aged 20-64; as expected, the increase is much smaller after age 65. Expansions were not associated with significant declines in initiation of treatment paid for in other ways including Medicare insurance, private insurance, or cash. Increases in treatment paid for with Medicaid insurance were concentrated in age-sex groups with higher prevalence of untreated diabetes and hypertension prior to the Affordable Care Act.