Uninsured patients face more ER visits, higher risks like amputations, and increased costs for both individuals and the healthcare system.
A recent study from Oregon Health & Science University highlights how interruptions in health insurance can significantly affect individuals living with diabetes, making disease management more challenging when coverage is lost. ()
Published in JAMA Health Forum, the study found that low-income adults who experienced repeated breaks in their insurance—referred to as “insurance churn”—had poorer glucose control and were more likely to require advanced treatment options compared to those with uninterrupted coverage.
Insurance Loss Leads to Worsening Health in Diabetes Patients
“Our goal was to understand what happens after people with diabetes lose insurance,” said lead author Nathalie Huguet, Ph.D., an associate professor of family medicine in the OHSU School of Medicine. “We already know they are more likely to churn out of coverage. This study shows that once they do, their health often gets worse.”
Researchers analyzed electronic health records from more than 39,000 adults treated at community health centers across 20 states. These clinics largely serve people living in or near poverty. Those who lost insurance were compared with others who were nearly identical at the start of the study.
“Even though they all started at the same baseline, the patients who lost insurance had worse outcomes,” Huguet said. “They needed more medications and that raises a big question: How can people manage complex diabetes treatment without coverage?”
Insurance Loss Drives Higher Insulin Use and Intensive Diabetes Care
The study found increases in insulin use and other high-intensity diabetes treatments among patients who lost insurance. Serious complications were less common during the study period, but Huguet said that may reflect limited follow-up time.
“Serious complications like amputations or kidney failure don’t happen overnight,” she said. “What we’re seeing is an early warning sign. The disease gets harder to manage after insurance loss.”
The findings build on Huguet’s earlier research showing that low-income patients with diabetes are more likely to experience insurance instability. Together, the studies suggest coverage gaps are not just a paperwork problem — they are a direct threat to health.
Huguet said the results are especially concerning as millions of Americans face potential Medicaid losses and rising insurance premiums in 2026.
Medicaid Loss Leaves Patients Facing High Costs and Limited Care Access
“Many people who lose Medicaid don’t regain coverage for a long time,” she said. “Marketplace plans are expensive, and insulin is still unaffordable for many people without insurance.” Community health centers often provide discounted medications, but many rely heavily on Medicaid funding.
“If Medicaid coverage shrinks, clinics will struggle to care for these patients. We need to increase support to primary care clinics so they can continue to serve their patients and keep the damage of losing insurance to a minimum,” said co-author Jennifer DeVoe, M.D., D.Phil., a professor of family medicine in the OHSU School of Medicine who holds the John and Sherrie Saultz Professorship in Family Medicine Innovation.
References:
- Insurance Churn and Diabetes Outcomes Among Patients with Low Income – (https://jamanetwork.com/journals/jama-health-forum/fullarticle/2846548)
Source-Eurekalert