Dr. Cole

Medicaid Expansion Linked to Improved in Hypertension and Diabetes Outcomes, especially in Minority Patients

MedicalResearch.com Interview with:

Dr. Cole

Megan B. Cole, PhD, MPH
Assistant Professor | Dept. of Health Law, Policy, & Management
Co-Director | BU Medicaid Policy Lab
Boston University School of Public Health
Boston, MA 02118

MedicalResearch.com: What is the background for this study?

Response: Under the Affordable Care Act, states were given the option to expand Medicaid eligibility to nonelderly adults with incomes up to 138% of the federal poverty level, where in January 2014, 25 states plus Washington, DC expanded eligibility, with 13 additional states expanding thereafter. State Medicaid expansion decisions were particularly consequential for federally qualified health centers (FQHCs), which serve nearly 30 million low-income, disproportionately uninsured patients across the US.

We know from earlier work that in the shorter-term, Medicaid expansion was associated with improvements in quality of care process measures and FQHC service capacity. However, we conducted the first known nationally representative study to examine how Medicaid expansion impacted key chronic disease outcome measures at FQHCs over the longer-term by looking at changes five years after implementation, including changes by race/ethnicity. 

MedicalResearch.com: What are the main findings?

Response: Our results found that after 5 years, Medicaid expansion was associated with large, sustained reductions in uninsurance rates at FQHCs, improvements in blood pressure control measures for hypertensive patients, and improvements in blood sugar control measures for diabetic patients. Black and Hispanic populations experienced the greatest magnitude of improvement in these measures, although racial/ethnic disparities still persisted post-expansion. 

MedicalResearch.com: What should readers take away from your report?

Response: These findings have several important takeaways.

First, expanding coverage to persons below the poverty level in the 12 states that have not yet expanded Medicaid may improve important health outcomes for patients with chronic conditions such as diabetes or hypertension.

Second, it’s important that we monitor and evaluate the longer-term effects of policies like Medicaid expansion, rather than relying only on shorter-term results, as it takes time for health outcomes to be clinically affected.

Finally, Medicaid expansion may be particularly beneficial to racial and ethnic groups that experience health disparities. However, expansion alone will not address inequities in health outcomes, and therefore must be accompanied by efforts that target quality improvement in racial/ethnic minority populations, that address the social determinants of health that underlie disparities, and that address structural and systemic racism, which ultimately drive inequities. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Future research should continue to monitor the longer-term effects of Medicaid expansion, and other coverage expansions, on low-income populations. Additionally, longer-term patient-level research that studies changes in health outcomes in individual patients who gain coverage is also needed.

No disclosures.


Cole MB, Kim J, Levengood TW, Trivedi AN. Association of Medicaid Expansion With 5-Year Changes in Hypertension and Diabetes Outcomes at Federally Qualified Health Centers. JAMA Health Forum. 2021;2(9):e212375. doi:10.1001/jamahealthforum.2021.2375



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Last Updated on September 13, 2021 by Marie Benz MD FAAD