New research from Oregon Health & Science University released on Mar. 22 finds that losing health insurance can quickly worsen health for people with diabetes, especially among low-income adults. The study, published in JAMA Health Forum, shows that patients who experience interruptions in their coverage—referred to as insurance "churn"—have poorer blood sugar control and require more intensive medications compared to those who remain insured.
The findings are significant because they highlight the direct impact of insurance instability on the management of chronic diseases like diabetes. As millions of Americans face potential Medicaid losses and rising premiums in 2026, the study suggests that gaps in coverage are not just administrative issues but pose real threats to patient health.
Lead author Nathalie Huguet, Ph.D., associate professor of family medicine at OHSU School of Medicine, said, "Our goal was to understand what happens after people with diabetes lose insurance. We already know they are more likely to churn out of coverage. This study shows that once they do, their health often gets worse." Huguet added, "Even though they all started at the same baseline, the patients who lost insurance had worse outcomes. They needed more medications and that raises a big question: How can people manage complex diabetes treatment without coverage?"
Researchers analyzed electronic health records from over 39,000 adults treated at community health centers across 20 states. These clinics primarily serve individuals living in or near poverty. The study found increases in insulin use and other high-intensity treatments among those who lost insurance. While serious complications were less common during the study period, Huguet noted this may be due to 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."
Co-author Jennifer DeVoe, M.D., D.Phil., also emphasized the importance of supporting primary care clinics: "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." Huguet further explained that uninsured individuals are more likely to end up in emergency departments—a situation that can lead to life-changing outcomes such as amputations and higher costs for both patients and the healthcare system.
The project was supported by funding from the Centers for Disease Control and Prevention (CDC) and included contributions from several OHSU researchers as well as collaborators from OCHIN, Inc., and Clackamas Health Centers.
