# ACE-D: Assess insurance Coverage Expansion on Diabetes complications

> **NIH ALLCDC U18** · OREGON HEALTH & SCIENCE UNIVERSITY · 2020 · $445,328

## Abstract

Project Summary
As of 2017, over 30 million people in the United States live with diabetes mellitus (DM). DM has many acute
and chronic complications (e.g., cellulitis, urinary tract infection, angina and ischemic heart disease, etc.).
Patients with DM need access to healthcare (e.g., prescription medications, diabetic eye exams, laboratory
monitoring) to control, manage DM, and prevent DM-related complications, a challenging task for patients
without continuous health insurance. The Patient Protection and Affordable Care Act (ACA) substantially
increased health insurance rates through Medicaid eligibility expansions (in states that chose to expand) and
nationwide individual health insurance marketplaces. We studied the impact of the early uptake of Medicaid
expansion (2014) on access to and delivery of healthcare among patients with DM in low-income populations
and found a greater uptake of health insurance in states that expanded Medicaid relative to those that did not,
as well as increased access to preventive care and improved DM control. With increased access to needed
care, it is hypothesized that ACA Medicaid expansions will reduce the incidence of DM-related complications;
however, this hypothesis has not yet been formally tested. Further, beyond insurance coverage, there are a
number of other individual- and community-level social determinants of health (SDH) that likely impact DM-
related health outcomes. To our knowledge, no study has investigated how neighborhood or individual
characteristics influence the effects of the ACA on DM-related complications. We will leverage electronic health
record data from the national ADVANCE clinical research network of community health centers (CHCs) which
has patient-level data from 801 CHCs in 22 Medicaid expansion states (n=177,125 adult patients with DM) and
460 CHCs in 7 non-expansion states (n=104,849 adult patients with DM). We will also link these EHR data
with mortality and community-level SDH data. The aims of this project are to: 1) evaluate the long-term impact
of ACA Medicaid expansions on DM-related complications. 2) compare DM-related complications for those
with stable health insurance versus those with unstable coverage; and, 3) understand the moderating effect of
individual- and community-level SDH on the relationship between ACA Medicaid expansions and DM-related
complications. Our findings will be critical to informing current decisions being made regarding the future of the
ACA and additional healthcare reforms being brought forth that could impact millions of patients living with DM.

## Key facts

- **NIH application ID:** 10092802
- **Project number:** 1U18DP006536-01
- **Recipient organization:** OREGON HEALTH & SCIENCE UNIVERSITY
- **Principal Investigator:** Nathalie Huguet
- **Activity code:** U18 (R01, R21, SBIR, etc.)
- **Funding institute:** ALLCDC
- **Fiscal year:** 2020
- **Award amount:** $445,328
- **Award type:** 1
- **Project period:** 2020-09-30 → 2025-09-29

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10092802

## Citation

> US National Institutes of Health, RePORTER application 10092802, ACE-D: Assess insurance Coverage Expansion on Diabetes complications (1U18DP006536-01). Retrieved via AI Analytics 2026-05-21 from https://api.ai-analytics.org/grant/nih/10092802. Licensed CC0.

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