When people with diabetes lose health insurance, their condition doesn’t just get worse; In a new study, OHSU researchers say it gets even worse.
Researchers say the findings demonstrate how quickly insurance coverage interruptions can disrupt treatment for chronic diseases such as diabetes, which require regular monitoring, medication adjustments, and consistent access to treatment.
The results are particularly alarming, as new eligibility requirements in President Donald Trump’s tax and spending law could leave millions of Americans without Medicaid coverage, while rising premiums in the Affordable Care Act’s marketplace are making private insurance increasingly unaffordable.
“What we’re seeing are early warning signs,” says lead author Dr. Natalie Huge, associate professor of family medicine at Oregon Health and Science University. “When you lose insurance, it becomes difficult to manage your disease.”
In Oregon, about 1.4 million residents, or roughly one in three people, receive insurance through the state’s Medicaid program, the Oregon Health Plan. The state estimates that up to 200,000 people could lose care.
The Oregon Medical Association estimates that approximately 14% of Oregon Health Plan members will be diagnosed with diabetes in 2024.
The study, published in JAMA Health Forum, found that low-income diabetic adults who lost insurance, even temporarily, were more likely to lose blood sugar control, develop complications, and require insulin within a few months than similar patients who remained insured.
The study analyzed the electronic health records of more than 39,000 adults treated at community health centers in 20 states between 2014 and 2019. Almost all of the patients studied were low-income, with about 90% living at or near the federal poverty level.
Researchers compared patients who joined and dropped insurance to similar patients who remained insured to better understand what happens when they lose insurance in light of health conditions and demographic factors.
“Even though everyone started with the same baseline, outcomes were worse for patients who lost insurance,” Huguet said in a statement. “They need more drugs, and that raises a big question: How can people cope with complex diabetes treatment without insurance?”
Managing diabetes requires consistent care, including regular doctor visits, laboratory tests, and medications, the authors said. When insurance lapses, patients may delay treatment, skip medications or struggle to pay for treatment, they said.
In the study, researchers found that diabetics who lost insurance were significantly more likely to develop complications such as dangerously high blood sugar levels. Insulin use is also rapidly increasing among the uninsured, indicating that diabetes is becoming harder to control.
In contrast, diabetic patients who remained insured were more likely to see improvements in glycemic control over time.
The authors noted that the study included only patients seen at multiple clinics and relied on data from health centers that participated in the study, which may not reflect care received elsewhere. Still, the results were consistent across different analyses, they said.
The findings build on Huguet’s research from last year showing that low-income adults with diabetes, especially those with more severe or complex conditions, are more likely to lose health insurance and cycle in and out of health insurance.
“This shows that even short-term interruptions in insurance coverage can have serious consequences for people managing chronic conditions,” the authors write. “Continued coverage is important.”
State officials have warned that stricter Medicaid eligibility requirements under the One Big Beautiful Bill Act could strip up to 200,000 Oregonians of coverage, but a separate new analysis by the Robert Wood Johnson Foundation and Urban Institute estimates that number could reach as many as 248,000.
Researchers at the Robert Wood Johnson Foundation say Medicaid enrollees most at risk of losing coverage are the self-employed, students, caregivers, and seniors. Many said they could lose coverage not because they are ineligible, but because they are struggling to keep up with stricter reporting requirements and more frequent eligibility checks.
“Many people who lose Medicaid don’t get their coverage back for a long time,” Huguet said. “Marketplace plans are expensive, and insulin remains unaffordable for many people without insurance.”
Community health centers, which serve many patients near or below the poverty line, may also be feeling the strain. When a patient loses Medicaid coverage, clinics often lose reimbursement and are limited in their ability to provide treatments and discounted medications.
“If Medicaid coverage decreases, clinics will struggle to care for these patients,” said Dr. Jennifer DeVoe, professor of family medicine at OHSU and co-author of the study. “We need to step up our support so that primary care clinics can continue to serve their patients.”
Researchers say that when patients lose access to reliable treatment, they delay treatment or withhold medication until the problem becomes urgent, a pattern often seen in gaps in insurance coverage.
“People who don’t have insurance are more likely to end up in the emergency room,” Huguet says. “It can lead to life-altering consequences and ultimately increases costs for patients and the health care system as a whole.”
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