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Association of the Affordable Care Act Medicaid Expansion with Dilated Eye Examinations among the United States Population with Diabetes.
Ophthalmology. 2020 07; 127(7):920-928.O

Abstract

PURPOSE

To evaluate the association between Medicaid expansion and diabetic dilated eye examinations.

DESIGN

A retrospective difference in differences (DiD) analysis using individual-level survey response data from January 1, 2009, to December 31, 2017.

PARTICIPANTS

A total of 52 392 survey responses from 50 states and the District of Columbia between 2009 and 2017. Responders were adults aged 18 to 64 years reporting a previous diagnosis of diabetes and a household income below 138% of the US federal poverty line (FPL).

METHODS

The Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System data were used to identify survey responders who were asked about the presence of dilated eye examinations from years before and after Medicaid expansion implementation.

MAIN OUTCOME MEASURES

The DiD in proportion of dilated eye examinations among diabetic persons aged 18 to 64 years with household incomes below 138% of the FPL between states that did and did not implement Medicaid expansion.

RESULTS

Implementation of Medicaid expansion policies was associated with a 1.3% (95% confidence interval [CI], -3.8 to 6.4; P = 0.61), 6.3% (95% CI, 1.3-11.3; P = 0.016), 4.1% (95% CI, -0.8 to 9.0; P = 0.11), and 2.3% (95% CI, -1.6 to 6.2; P = 0.23) increase in the proportion of diabetic persons aged 18 to 64 years with incomes below 138% of the FPL receiving a dilated eye examination within the past year due to Medicaid expansion 1, 2, 3, and 4 cumulative years after expansion, respectively.

CONCLUSIONS

Medicaid expansion policies were significantly associated with an increase in dilated eye examination rates within the first 2 years after implementation. However, this increase did not persist beyond this period, with nonsignificant increases 3 and 4 cumulative years after implementation. Healthcare policymakers should be aware that additional measures beyond expanding insurance coverage may be necessary to increase and sustain the rate of dilated eye examinations among diabetic populations.

Authors+Show Affiliations

Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut.Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts; Retina Service, Massachusetts Eye and Ear, Boston, Massachusetts.Department of Statistics and Institute for Health Care Policy and Aging Research, Rutgers University, Piscataway, New Jersey.Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut.Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts; Retina Service, Massachusetts Eye and Ear, Boston, Massachusetts; Manhattan Retina and Eye Consultants, New York, New York; New York University School of Medicine, New York, New York. Electronic address: Rap120@mail.harvard.edu.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

31735405

Citation

Chen, Evan M., et al. "Association of the Affordable Care Act Medicaid Expansion With Dilated Eye Examinations Among the United States Population With Diabetes." Ophthalmology, vol. 127, no. 7, 2020, pp. 920-928.
Chen EM, Armstrong GW, Cox JT, et al. Association of the Affordable Care Act Medicaid Expansion with Dilated Eye Examinations among the United States Population with Diabetes. Ophthalmology. 2020;127(7):920-928.
Chen, E. M., Armstrong, G. W., Cox, J. T., Wu, D. M., Hoover, D. R., Del Priore, L. V., & Parikh, R. (2020). Association of the Affordable Care Act Medicaid Expansion with Dilated Eye Examinations among the United States Population with Diabetes. Ophthalmology, 127(7), 920-928. https://doi.org/10.1016/j.ophtha.2019.09.010
Chen EM, et al. Association of the Affordable Care Act Medicaid Expansion With Dilated Eye Examinations Among the United States Population With Diabetes. Ophthalmology. 2020;127(7):920-928. PubMed PMID: 31735405.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of the Affordable Care Act Medicaid Expansion with Dilated Eye Examinations among the United States Population with Diabetes. AU - Chen,Evan M, AU - Armstrong,Grayson W, AU - Cox,Jacob T, AU - Wu,David M, AU - Hoover,Donald R, AU - Del Priore,Lucian V, AU - Parikh,Ravi, Y1 - 2019/09/17/ PY - 2019/06/02/received PY - 2019/09/05/revised PY - 2019/09/09/accepted PY - 2019/11/19/pubmed PY - 2019/11/19/medline PY - 2019/11/19/entrez SP - 920 EP - 928 JF - Ophthalmology JO - Ophthalmology VL - 127 IS - 7 N2 - PURPOSE: To evaluate the association between Medicaid expansion and diabetic dilated eye examinations. DESIGN: A retrospective difference in differences (DiD) analysis using individual-level survey response data from January 1, 2009, to December 31, 2017. PARTICIPANTS: A total of 52 392 survey responses from 50 states and the District of Columbia between 2009 and 2017. Responders were adults aged 18 to 64 years reporting a previous diagnosis of diabetes and a household income below 138% of the US federal poverty line (FPL). METHODS: The Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System data were used to identify survey responders who were asked about the presence of dilated eye examinations from years before and after Medicaid expansion implementation. MAIN OUTCOME MEASURES: The DiD in proportion of dilated eye examinations among diabetic persons aged 18 to 64 years with household incomes below 138% of the FPL between states that did and did not implement Medicaid expansion. RESULTS: Implementation of Medicaid expansion policies was associated with a 1.3% (95% confidence interval [CI], -3.8 to 6.4; P = 0.61), 6.3% (95% CI, 1.3-11.3; P = 0.016), 4.1% (95% CI, -0.8 to 9.0; P = 0.11), and 2.3% (95% CI, -1.6 to 6.2; P = 0.23) increase in the proportion of diabetic persons aged 18 to 64 years with incomes below 138% of the FPL receiving a dilated eye examination within the past year due to Medicaid expansion 1, 2, 3, and 4 cumulative years after expansion, respectively. CONCLUSIONS: Medicaid expansion policies were significantly associated with an increase in dilated eye examination rates within the first 2 years after implementation. However, this increase did not persist beyond this period, with nonsignificant increases 3 and 4 cumulative years after implementation. Healthcare policymakers should be aware that additional measures beyond expanding insurance coverage may be necessary to increase and sustain the rate of dilated eye examinations among diabetic populations. SN - 1549-4713 UR - https://www.unboundmedicine.com/medline/citation/31735405/Association_of_the_Affordable_Care_Act_Medicaid_Expansion_with_Dilated_Eye_Examinations_among_the_United_States_Population_with_Diabetes_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0161-6420(19)32056-1 DB - PRIME DP - Unbound Medicine ER -