The Affordable Care Act (ACA) Medicaid expansion program may have helped many people with diabetes keep their feet.
Dr. Tze-Woei Tan, a surgeon on the faculty of the University of Arizona medical school, and colleagues have published data supporting that possibility in an analysis of data on 25,493 non-white Medicaid enrollees and 9,863 uninsured patients who suffered from diabetic foot ulcerations, or a sore or wound that would not heal.
For minorities ages 20 to 64, with Medicaid in states that used ACA money to expand their Medicaid programs early, the number of hospital admissions for diabetic foot ulcerations climbed 181%, and the number of diabetic foot ulceration admissions for uninsured patients fell 21.5%.
In an early-Medicaid-expansion state, the odds that doctors would cut off the toe of a patient with a diabetic foot ulcer, or perform another form of “minor amputation,” increased 14%.
But, because surgeons performed relatively minor procedures in time to keep infections from spreading, the odds that surgeons would have to perform “major amputations” — amputations of the foot above the ankle, or even amputations of entire legs — fell 17%.
- A copy of the Tan team’s amputation article is available here.
- An article about U.S. diabetes trends is available here.
The picture was different in states that declined to expand their Medicaid programs.
There, the number of hospital admissions for uninsured people with diabetic foot ulcerations increased 78%.
The odds the patients with diabetic foot ulcerations in the non-expansion states would have toe amputations, or other minor amputations, fell 8%, but the odds that they would lose their feet or legs increased 1%.