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Impact of Affordable Care Act on Type 2 Diabetes

The Affordable Care Act (ACA) passed in 2010 was a major milestone in the U.S.
healthcare system as it significantly increased the number of people with insurance coverage.
Among the beneficiaries of this policy are persons at risk or living with diabetes, particularly
African Americans. While diabetes is a major health problem in the U.S., and indeed the world,
it disproportionately affects African Americans. 13% of African Americans are living with the
condition which has become one of the leading causes of deaths in this population group (Walker
et al., 2016). Apart from death, complications of diabetes are also more severe among African
Americans than in many other ethnic groups. For instance, compared to whites, African
Americans are 4.2 times more likely to develop renal diseases caused by diabetes, twice more
likely to be admitted in hospitals due to diabetes, and 3.5 times more likely to suffer from lower
extremity amputations (Walker et al., 2016).
One of the reasons why mortality rates and complications resulting from type 2 diabetes
are greater among African Americans is because of lack of insurance coverage. Due to their
relatively low socio-economic status, African Americans are more likely not to have insurance
coverages than other population groups (Walker et al., 2016). Lack of insurance coverage means
that they are likely to be diagnosed late, they may not be able to have regular check ups, or
afford medications needed for diabetes management (Walker et al., 2016). The Affordable Care
Act addresses this problem in multiple ways. First, it allows for free preventive care (Powers et
al., 2016). In the case of diabetes this measure means that people can now benefit from free
diabetes screenings. These screenings are likely to significantly increase the number of African
Americans whose diabetes gets detected early. Additionally, the Act expands Medicaid and

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provides government subsidies through various insurance marketplace plans (Powers et al.,
2016). As a result of these measures many African Americans who would have otherwise not
been covered by insurance companies are going to be covered. For African Americans living
with diabetes, this coverage means better management of diabetes because they will be able to
comfortably have regular check ups and get the required prescribed medications. Equally
important, the Affordable Care Act put an end to denial of coverage due presence of pre-existing
conditions (Powers et al., 2016). Prior to enactment of ACA, many African Americans with
diabetes could not get health insurance coverage due to their condition. They, therefore, had to
pay out of pocket which is very costly. Lastly, ACA allows young adults to be covered under
their guardian’s or parent’s name (Powers et al., 2016). This measure will help many young
African Americans with diabetes or at risk of acquiring diabetes receive effective preventive care
and treatment.
With the enactment of ACA, Family Nurse Practitioners, will play a bigger role in
dealing with the problem of high diabetes prevalence among African Americans. Family Nurse
Practitioners are at the forefront of helping patients manage not just acute but also chronic
conditions such as diabetes. Apart from performing diagnostic procedures and tests, they also
help patients take practical steps to manage their conditions in an effective manner. Before the
enactment of ACA, many African Americans at risk of getting diabetes or living with the
condition could not receive effective care from family nurse practitioners because they did not
have health insurance. Family Nurse Practitioners could, therefore, not provide services to them
because they would not be reimbursed for the services. With the enactment of ACA, Family
Nurse Practitioners are going to play a more prominent role in the fight against diabetes among
African Americans because of certainty of reimbursement of their services.

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Apart from increasing the prominence of family nurse practitioners in management of
diabetes among African Americans, the Affordable Care Act is also going to have a major
influence on clinical practice. The Act promotes preventive healthcare model (Powers et al.,
2016). This model emphasizes quality care, community health initiatives, and primary care
(Powers et al., 2016). With regard to diabetes, this approach means taking a more population
health approach that seeks to reduce the role of certain factors that make diabetes more prevalent
among African American communities (Powers et al., 2016). To this end, instead of treatment,
more emphasis will be placed on patient education, living healthy lifestyle, and improvement of
self-management for patients living with diabetes (Powers et al., 2016). In general, the new
approach will have culturally tailored initiatives that are suitable in addressing unique problems
among African American communities with the goal of improving diabetes management, health
outcomes, and reducing health disparities.
In addition to placing more emphasis on population health approach, ACA is also going
to lead to more inter-professional team approach. With a focus on prevention rather than
treatment, nutritionists, pharmacists, physicians, nurses, and psychologists will have to
collaborate to achieve the best health outcomes possible for diabetes patients in the African
American community.
In conclusion, the enactment of Affordable Care Act has brought positive changes in the
healthcare industry that are going to help in the reduction of prevalence of diabetes among
African Americans. In particular, the expansion of insurance coverage among this population
subgroup is going to reduce one of the biggest barriers to diabetes management among African
Americans – cost. The new measures will also increase the prominence of the role played by

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family nurse practitioners in addressing the problem of high prevalence rates of diabetes among
African Americans.

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References

Powers, A. C., Wexler, J. A., Lash, R. W., Dyer, M. C., Becker, M. N., & Vigersky, R. A.
(2016). Affordable Care Act Implementation: Challenges and Opportunities to Impact
Patients With Diabetes. The Journal of Clinical Endocrinology & Metabolism, 101(4),
1315-1317.
Walker, R. J., Williams, J. S., & Egede, L. E. (2016). Influence of race, ethnicity and social
determinants of health on diabetes outcomes. The American journal of the medical
sciences, 351(4), 366-373.