Medicaid Expansion Linked to Fewer Amputations for Minority Patients With Diabetes

diabetic foot ulcer
“A photograph of a senior woman’s calloused and ulcerated diabetic foot. This patient is dealing with an ulcer on this foot for the second time. High blood sugar affects nerves and blood vessels in the feet, causing them to lose their ability to function properly. Damage to the blood vessels and nerves takes away feeling putting them at a higher risk for trauma. This patient did not feel the first ulcers on the bottom of her foot until it was too late. Extreme infection had set in and antibiotics were ineffective. Parts of the bone in her foot were removed and replaced with steel plates and the top portion of her second toe had to be amputated. The patient has been undergoing treatment for this new ulcer on an outpatient basis. Please see my other images of this patient’s foot to compare the healing progress. Similar Images”
Medicaid expansion is linked to reductions in major lower extremity amputations among racial and ethnic minority patients with diabetic foot ulcers.

The following article is part of coverage from the American Diabetes Association’s 80th Scientific Sessions (ADA 2020). Because of concerns regarding the coronavirus disease 2019 (COVID-19) pandemic, all ADA 2020 sessions and presentations were transitioned to a virtual format. While live events will not proceed as planned, readers can click here to view more news related to research presented during the ADA 2020 virtual experience.

Medicaid expansion under the Affordable Care Act (ACA) is associated with significant reductions in major lower extremity amputations among racial and ethnic minority patients with diabetic foot ulcers, according to study results presented during the American Diabetes Association’s 80th Scientific Sessions, held online from June 12 to 16, 2020.

Using information from State Inpatient Databases, researchers examined whether Medicaid expansion affected care outcomes of minority Medicaid beneficiaries who had diabetic foot ulcerations between 2013 and 2015. The analysis included 25,493 minority Medicaid beneficiaries and 9863 patients without insurance from 19 states, which were categorized as either an early-adopter or nonadopter state based on their implementation of the ACA expansion by January 2014.

In the early-adopter states, there was a 180.7% increase in the number of inpatient admissions for Medicare beneficiaries after expansion. These states also had a 21.5% decrease in admissions for uninsured patients. Alternatively, the states that did not implement Medicaid expansion had a 78.2% increase in the number of inpatient admissions for uninsured patients.

With regard to lower extremity amputations, the odds of major amputation decreased by 17.3% among minority Medicare beneficiaries with diabetic foot ulcers in the early-adopter states and increased by 0.9% in states that did not expand Medicare (P =.045). Conversely, the odds of minor amputations increased by 14% in the early-adopter states, but decreased by 8.1% in the states that did not expand Medicare coverage (P =.003).

“The ACA Medicaid expansion appears to have substantial positive effects on the care of minorities with [diabetic foot ulcers],” concluded the researchers, adding that overall broadening of the ACA “may reduce disparities in diabetes-related amputations.”


Tan T-W, Calhoun E, Knapp SM, Marrero DG, Zhou W, Armstrong DG. ADA presidents’ select abstract: the Affordable Care Act Medicare expansion correlated with reduction in lower extremity amputation among minorities with diabetic foot ulcerations. Presented at: American Diabetes Association 80th Scientific Sessions; June 12-16, 2020. Abstract 217-OR.

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