Losing health insurance can quickly worsen health for people with diabetes as patients struggle to control the disease after coverage is interrupted, according to new research from Oregon Health & Science University,
The study, published today in JAMA Health Forum , found that low-income adults with diabetes who experienced insurance “churn” — defined as losing coverage for multiple medical visits — had poorer blood sugar control and needed more intensive medications than similar patients who stayed insured.
“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?”
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.”
Access to Medicaid
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.
“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.
“People without insurance are more likely to end up in the emergency department,” Huguet said. “That can lead to life-changing outcomes, like amputations, and it ultimately costs more for patients and the entire health system.”
In addition to Huguet and DeVoe, other OHSU co-authors include: Dang Dinh, M.S. , Jun Hwang, M.S. , and Miguel Marino, Ph.D. , as well as Annie Larson, Ph.D. , with OCHIN, Inc., and Andrew Suchocki, M.D., M.P.H., FAAFP , with Clackamas Health Centers.
This project was supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services as part of a financial assistance award totaling $2,275,360 with 100 percent funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U.S. Government.
JAMA Health Forum
10.1001/jamahealthforum.2026.0034
Case study
People
Insurance Churn and Diabetes Outcomes Among Patients with Low Income
20-Mar-2026