The adoption of the Affordable Care Act (ACA)1 in the USA expanded health insurance for low-income Americans and took two main forms: Medicaid expansion in some states and subsidized private health insurance through insurance exchanges available in all states, with deep subsidies for persons with incomes from 138% to 250% of the federal poverty limit (FPL) in Medicaid expansion states and from 100% to 250% of the FPL in non-expansion states. Prior studies found a statistically significant slightly negative2 effects of the ACA on diabetes diagnoses and controversial (from insignificantly slightly positive3 to significantly positive4) effects on diabetes therapies at county and state levels. We examined the effect of both forms of ACA reform on the improvement of diabetes diagnostics and management in low-income patients who had access to healthcare before the ACA expansion (2011–2013). We used electronic health records (EHR) from 11 major academic health systems in 8 states in the USA (Illinois, Iowa, Wisconsin, Kansas, Nebraska, Missouri, Texas, Indiana). The sample (see table 1 for demographics) was limited to patients aged 55–74 over 2011–2018 who used care (any encounter type) at the study facilities at least once in the pre-expansion period. Due to inconsistent depiction of insurance status in EHR, patient residence in a socially deprived5 census tract (see online supplemental appendix for details) was used as proxy for persons who were more likely to gain insurance under the ACA. Therefore persons aged 55–64 from the socially deprived …

中文翻译：

---

《平价医疗法案》对主要医疗中心糖尿病护理的影响：新发现的糖尿病和糖尿病药物管理

美国通过的平价医疗法案 (ACA)1 扩大了低收入美国人的医疗保险并采取了两种主要形式：在一些州扩大医疗补助计划，并通过在所有州提供的保险交换补贴私人医疗保险，并为在医疗补助扩张州，收入在联邦贫困线 (FPL) 的 138% 到 250% 之间，在非扩张州，收入在联邦贫困线 (FPL) 的 100% 到 250% 之间的人。先前的研究发现，ACA 对糖尿病诊断有统计学上显着的轻微负面影响 2，而在县和州一级对糖尿病治疗产生有争议的（从微不足道的轻微正面 3 到显着正面 4）的影响。我们检查了两种形式的 ACA 改革对改善在 ACA 扩张前（2011-2013 年）之前获得医疗保健的低收入患者的糖尿病诊断和管理的影响。我们使用了来自美国 8 个州（伊利诺伊州、爱荷华州、威斯康星州、堪萨斯州、内布拉斯加州、密苏里州、德克萨斯州、印第安纳州）的 11 个主要学术卫生系统的电子健康记录 (EHR)。样本（人口统计数据见表 1）仅限于 2011-2018 年 55-74 岁的患者，他们在扩展前期间在研究设施中至少使用过一次护理（任何遇到类型）。由于 EHR 中对保险状况的描述不一致，患者居住在社会贫困人口普查区（详见在线补充附录）被用作更有可能根据 ACA 获得保险的人的代表。