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.


J.M. Lobo: None. S. Kim: None. G.M. Ocker: None. H. Kang: None. T.L. McMurry: None. M. Sohn: None.


National Institute of Diabetes and Digestive and Kidney Diseases (R01DK113295)

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