Dr. David Armstrong
Expanding the Affordable Care Act has had a significant impact on reducing diabetes-related amputations among poor minorities, according to a paper written by David G. Armstrong, DPM, PhD, professor of surgery, and published as the American Diabetes Association’s select President’s Abstract.
In the paper, titled “The Affordable Care Act Medicaid Expansion Correlated with Reduction in Lower Extremity Amputation among Minorities with Diabetic Foot Ulcerations,” Armstrong and his team argue that “lack of insurance and non-white race are associated with increased risks of amputation.” Armstrong and his team analyzed databases in 19 states to identify people who either lacked health insurance or were on Medicaid, and who had a diabetic foot ulceration (DFU), an open sore that appears on the feet of diabetics and can lead to amputation. The goal of the analysis was to “evaluate the effect of Medicaid expansion under the Affordable Care Act (ACA) on outcomes of minorities with DFUs.”
Armstrong and his colleagues found that, among minorities age 20 to 64 with DFUs who were on Medicaid and lived in states that were “early adopters” of Medicaid expansion under ACA (by January 2014), there was an increase of 180.7% in admissions after expansion. Among the uninsured, there was a decrease of 21.5% in admissions. In states that chose not to expand Medicaid, admissions of uninsured patients went up 78.2 percent. The odds of a major amputation dropped 17.3% in early-adopter states, and increased 0.9% in non-adopter states.
“The ACA Medicaid expansion appears to have substantial positive effects on the care of minorities with DFUs,” the authors wrote. “Racial and ethnic minorities in states that expanded Medicaid experienced a significant reduction in the number of uninsured with DFUs and a reduction in major amputations. The broadening of the ACA may reduce disparities in diabetes-related amputations.”
Others contributing to the paper were Tze-Woei Tan, Elizabeth Calhoun, Shannon M. Knapp, David G. Marrero, and Wei Zhou.