OBJECTIVE To assess national changes in health insurance coverage and related costs before and after implementation of the Affordable Care Act (ACA) among U.S. adults with diabetes.

RESEARCH DESIGN AND METHODS Data were cross-sectional from the 2009 and 2016 National Health Interview Surveys (NHIS). Participants were adults age ≥18 years with a previous diagnosis of diabetes who self-reported on their health insurance coverage, demographic information, diabetes-related factors, and amount spent on medical expenses and insurance premiums (N = 6,220).

RESULTS Among adults with diabetes age 18–64 years, health insurance coverage increased from 84.7% in 2009 to 90.1% in 2016 (P < 0.001). Coverage remained near universal for those age ≥65 years (99.5%). For adults age 18–64 years, coverage increased for almost all subgroups and significantly for men; non-Hispanic whites, non-Hispanic blacks, and Hispanics; those who were married; those with less than or more than a high school education, family income <$35,000, or diabetes duration <5 or >15 years; and those taking oral agents (P < 0.05 for all). Among adults age 18–64 years, Medicaid coverage significantly increased between 2009 and 2016 (19.4% vs. 24.3%, P = 0.006), and for those with private insurance, 7.8% acquired their plan through HealthCare.gov. For adults age ≥65 years, private insurance decreased and Medicare Part D increased (P < 0.007 for both). Among those age 18–64 years with an income <$35,000, the proportion of income spent on family medical costs decreased (6.3% vs. 4.8% for 2009 vs. 2016, respectively; P = 0.004).

CONCLUSIONS Health insurance coverage among adults with diabetes age 18–64 years increased significantly after implementation of the ACA, and medical costs to families decreased among those with lower incomes.

目的评估美国成年糖尿病患者在实施《负担得起的医疗法案》（ACA）之前和之后在健康保险范围和相关费用方面的国家变化。

研究设计和方法数据来自2009年和2016年国家健康访问调查（NHIS）。参与者为年龄≥18岁且先前被诊断出患有糖尿病的成年人，他们自我报告了自己的健康保险范围，人口统计信息，糖尿病相关因素以及用于医疗费用和保险费的金额（N = 6,220）。

结果在18-64岁的成年人中，健康保险的覆盖率从2009年的84.7％增加到2016年的90.1％（P <0.001）。≥65岁的人群的覆盖率仍然接近全民（99.5％）。对于18-64岁的成年人，几乎所有亚组的覆盖率都有所增加，而男性则显着增加。非西班牙裔白人，非西班牙裔黑人和西班牙裔；那些已婚的人；那些受过以下教育的人：高中或以下，家庭收入<$ 35,000，或糖尿病持续时间<5或> 15岁；以及服用口服药物的患者（全部P <0.05）。在18-64岁的成年人中，医疗补助覆盖率在2009年至2016年间显着增加（分别为19.4％和24.3％，P= 0.006），而拥有私人保险的人中，有7.8％通过HealthCare.gov获得了他们的计划。对于65岁以上的成年人，私人保险减少而Medicare D部分增加（两者均P <0.007）。在收入低于35,000美元的18-64岁年龄段中，用于家庭医疗费用的收入比例下降了（2009年与2016年分别为6.3％和4.8％；P = 0.004）。

结论实施ACA后，年龄在18-64岁之间的成年人中的健康保​​险覆盖率显着增加，而收入较低的家庭中对家庭的医疗费用则下降了。