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Current Diabetes Reports

Erschienen in:

01.12.2015 | Health Care Delivery Systems and Implementation in Diabetes (EB Morton-Eggleston, Section Editor)

Affordable Care Act and Diabetes Mellitus

verfasst von: Qian Shi, Frank P. Nellans, Lizheng Shi

Erschienen in: Current Diabetes Reports | Ausgabe 12/2015

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Abstract

The Affordable Care Act (ACA) has the potential for great impact on U.S. health care, especially for chronic disease patients requiring long-term care and management. The act was designed to improve insurance coverage, health care access, and quality of care for all Americans, which will assist patients with diabetes mellitus in acquiring routine monitoring and diabetes-related complication screening for better health management and outcomes. There is great potential for patients with diabetes to benefit from the new policy mandating health insurance coverage and plan improvement, Medicaid expansion, minimum coverage guarantees, and free preventative care. However, policy variability among states and ACA implementation present challenges to people with diabetes in understanding and optimizing ACA impact. This paper aims to select the most influential components of the ACA as relates to people with diabetes and discuss how the ACA may improve health care for this vulnerable population.

1.•

Internal Revenue Service (IRS). The Health Insurance Marketplace. 2015; Available from: http://www.irs.gov/Affordable-Care-Act/Individuals-and-Families/The-Health-Insurance-Marketplace. This webpage provides the definition of Marketplace.

2.•

U.S. Centers for Medicare & Medicaid Services. Navigator. 2015; Available from: https://www.healthcare.gov/glossary/navigator/. This webpage provides the definition of the Marketplace Navigator.

3.••

U.S. Department of Health & Human Services. Young Adult Coverage. 2015; Available from: http://www.hhs.gov/healthcare/rights/youngadults/index.html. This webpage provides the provision of Young Adult Coverage.

4.•

Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion. Number (in Millions) of Civilian, Noninstitutionalized Persons with Diagnosed Diabetes, United States, 1980–2011. 2013; Available from: http://www.cdc.gov/diabetes/statistics/prev/national/figpersons.htm. This article provides the number of people with diabetes.

5.•

National Center for Chronic Disease Prevention and Health Promotion, Division of Diabetes Translation. Prediabetes. 2014; Available from: http://www.cdc.gov/diabetes/basics/prediabetes.html. This article provides the number of people with prediabetes.

6.•

Emerging Risk Factors Collaboration, Sarwar N, Gao P, Seshasai SR, Gobin R, Kaptoge S, et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet. 2010;375(9733):2215–22. This study shows the relatively higher burden of complications among people with type 2 diabetes.CrossRef

7.•

American Diabetes Association. Economic costs of diabetes in the U.S. in 2012. Diabetes Care. 2013;36(4):1033–46. This article is about the economic burden of diabetes for society.PubMedCentralCrossRef

8.•

Fletcher JM, Richards MR. Diabetes’s ‘health shock’ to schooling and earnings: increased dropout rates and lower wages and employment in young adults. Health Aff. 2012;31(1):27–34. The study shows the higher economic burden for people with diabetes compared to people without.CrossRef

9.••

U.S. Centers for Medicare & Medicaid Services. Essential Health Benefits. Available from: https://www.healthcare.gov/glossary/essential-health-benefits/. This webpage provides the official definition about ‘essential health benefits’.

10.••

National Conference of State Legislatures. State health insurance mandates and the ACA essential benefits provisions. 2014; Available from: http://www.ncsl.org/research/health/state-ins-mandates-and-aca-essential-benefits.aspx. The webpage provides the information about the scope of application of essential benefits in ACA.

11.•

National Center for Chronic Disease Prevention and Health Promotion, Division of Diabetes Translation, Diabetes Successes and Opportunities for Population-Based Prevention and Control At A Glance 2011. 2011. This article provides the evidence that people with diabetes have higher medical expense than people who do not.

12.•

U.S. Department of Health and Humans Services. At risk: pre-existing conditions could affect 1 in 2 Americans:129 million people could be denied affordable coverage without health reform. 2011. The report includes the number of people with a pre-existing condition who were denied by the health insurance before ACA.

13.•

Congress of the United States, Congressional Budget Office. Updated estimates of the effects of the insurance coverage provisions of the Affordable Care Act, April 2014. 2014. This report is about the estimation of the influence of ACA on workforce by CBO.

14.••

U.S. Centers for Medicare & Medicaid Services. Eligibility. Available from: http://www.medicaid.gov/AffordableCareAct/Provisions/Eligibility.html. This report provides the clauses about the eligibility of Medicaid Expansion in ACA.

15.•

The Henry J.Kaiser Family Foundation. Status of state action on the Medicaid Expansion Decision. 2015; Available from: http://kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/. This webpage provides the list of states that adopted or did not adopt Medicaid Expansion.

16.•

Center for American Progress. What will Medicaid expansion actually cost states? 2013; Available from: https://www.americanprogress.org/issues/healthcare/news/2013/04/02/58922/10-frequently-asked-questions-about-medicaid-expansion/. This webpage discussed about the federal budget support for the state adopting Medicaid Expansion.

17.•

U.S. Centers for Medicare & Medicaid Services. Income levels that qualify for lower health coverage costs. Available from: https://www.healthcare.gov/lower-costs/qualifying-for-lower-costs/ This webpage provides the details about how government subsidies help those low-income patients to get the protection of health insurance.

18.••

U.S. Department of Health & Human Services. Preventive services covered under the Affordable Care Act. 2012; Available from: http://www.hhs.gov/healthcare/facts/factsheets/2010/07/preventive-services-list.html#CoveredPreventiveServicesforWomenIncludingPregnantWomen. This report is about the preventive care people with diabetes can enjoy after ACA enactment.

19.••

U.S. Centers for Medicare & Medicaid Services. Medicare’s coverage of diabetes supplies & services. http://www.medicare.gov. This article provides the regulation about the benefits of preventive care that should be included into all of the Medicare plan without coinsurance, copayment, or Plan B deductible.

20.•

U.S. Centers for Medicare & Medicaid Services. Diabetes self-management training. Available from: http://www.medicare.gov/coverage/diabetes-self-mgmt-training.html. This report is about the benefit of diabetes self-management training in Medicare, which was designed for senior people with diabetes.

21.•

Indian Health Service, Division of Diabetes Treatment and Prevention. Step-by-step guide to Medicare Diabetes Self-Management Training (DSMT) Reimbursement. 2011. This report provides the benefit of diabetes management in Medicare, which was designed for senior people with diabetes.

22.••

American Association of Diabetes Educators. The Affordable Care Act and individuals with diabetes. This report provides the benefit of diabetes management, which was designed for people with diabetes.

23.•

Anderson A. The impact of the Affordable Care Act on the health care workforce. BACKGROUNDER. 2014. This paper provides the estimation of the challenge for the health workforce after ACA.

24.••

ObamaCare Facts. ObamaCare individual mandate. Available from: http://obamacarefacts.com/obamacare-individual-mandate/. This webpage is about the provision of every individual should have health insurance and share the responsibility.

25.•

ObamaCare Facts. ObamaCare’s individual mandate: what is the tax penalty for not having health insurance?; Available from: http://obamacarefacts.com/obamacare-individual-mandate/. This webpage provides the information that tax penalty in the future years will be placed on the people who do not have insurance.

26.•

ObamaCare Facts. ObamaCare employer mandate. This webpage provides the information about health insurance’s employer mandate and the encouragement and penalty in the future years.

27.••

ObamaCare Facts. ObamaCare: pros and cons of ObamaCare. Available from: http://obamacarefacts.com/obamacare-pros-and-cons/. This webpage provides the possible disadvantage of the health insurance mandate in ACA.

28.•

Internal Revenue Service. Part III administrative, procedural, and miscellaneous 2013. This report provides the estimation of the cost on a high deductible plan.

29.•

Chen S, Levin RA, Gartner JA. Medication adherence and enrollment in a consumer-driven health plan. The American Journal of Managed Care. 2010;16(2):e43-50. Epub 2010/02/13. This study provides the result that adherence was lower for a few drug classes among CDHP patients.

30.•

Nair KV, Park J, Wolfe P, Saseen JJ, Allen RR, Ganguly R. Consumer-driven health plans: impact on utilization and expenditures for chronic disease sufferers. J Occup Environ Med. 2009;51(5):594–603. This article discussed that switching to a CDHP resulted in lower utilization and adherence.CrossRefPubMed

31.•

Greene J, Hibbard J, Murray JF, Teutsch SM, Berger ML. The impact of consumer-directed health plans on prescription drug use. Health Aff. 2008;27(4):1111–9. This study provides the result that enrollment in a CDHP reduces adherence among those continuing their medication.CrossRef

32.•

Schillinger D, Grumbach K, Piette J, Wang F, Osmond D, Daher C, et al. Association of health literacy with diabetes outcomes. Jama. 2002;288(4):475–82. This study provides the results that literacy level matters and varies between people with diabetes.CrossRefPubMed

33.•

Cavanaugh KL. Health literacy in diabetes care: explanation, evidence and equipment. Diabetes Manag. 2011;1(2):191–9. This study mentioned that patients with diabetes had lower level of health literacy than others.CrossRef

34.•

Agency for Healthcare Research and Quality. 2014 National Healthcare Quality & Disparities Report. 2015. This report provides the evidence that ACA may have an influence on health disparity.

35.••

Agency for Healthcare Research and Quality. Diabetes disparities among racial and ethnic minorities: fact sheet. 2001. This fact sheet provides the information that diabetes places differential burden to racial/ethnic groups.

36.•

Agency for Healthcare Research and Quality. Population factors explain most between-State disparities in rates of gestational diabetes: disparities/minority health. 2014. The report provides the disparities of gestational diabetes that happened between states.

37.•

Bryant AS, Ayaba W, Caughey AB, Washington AE. Racial/ethnic disparities in obstetrical outcomes and care: prevalence and determinants. Am J Obstet Gynecol. 2010;202(4):335–43. This report provides the evidence that obstetrical healthcare/outcome disparity existed among women and women with gestational diabetes.PubMedCentralCrossRefPubMed

38.•

Chin MH, Clarke AR, Nocon RS, Casey AA, Goddu AP, Keesecker NM, et al. A roadmap and best practices for organizations to reduce racial and ethnic disparities in health care. J Gen Intern Med. 2012;27(8):992–1000. This report provides a roadmap for reducing the racial/ethnic healthcare disparity.PubMedCentralCrossRefPubMed

39.•

Ahmed Calvo LRC, Clement Bezold. A comprehensive health home: using the expanded care model of the collaboratives. 2008. This article provides the definition of PCMH.

40.•

Bojadzievski T, Gabbay RA. Patient-centered medical home and diabetes. Diabetes Care. 2011;34(4):1047–53. This paper discussed about the influence of PCMH on patients with diabetes and the mode of care.PubMedCentralCrossRefPubMed

41.•

Tsai AC, Morton SC, Mangione CM, Keeler EB. A meta-analysis of interventions to improve care for chronic illnesses. Am J Manag Care. 2005;11(8):478–88. This meta-analysis provides the evidence that PCMH is suitable for chronic disease care model.PubMedCentralPubMed

42.•

Kilo CM, Wasson JH. Practice redesign and the patient-centered medical home: history, promises, and challenges. Health Aff. 2010;29(5):773–8. This article provides the evidence that PCMH is beneficial for diabetes care.CrossRef

Titel: Affordable Care Act and Diabetes Mellitus
verfasst von: Qian Shi
Frank P. Nellans
Lizheng Shi
Publikationsdatum: 01.12.2015
Verlag: Springer US
Erschienen in: Current Diabetes Reports / Ausgabe 12/2015
Print ISSN: 1534-4827
Elektronische ISSN: 1539-0829
DOI: https://doi.org/10.1007/s11892-015-0679-1

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