Managed Care Cast

The last decade has brought great strides in diabetes care. Better insulins and better technology can allow people with diabetes—both type 1 and type 2—to keep their blood sugar from rising and falling in ways that cause long-term damage to their eyesight and vascular systems. New classes of drugs for patients with type 2 diabetes have been shown to cut the risk of heart and renal failure, and more widespread use could help some patients avoid dialysis. But the good news is not felt by everyone. Amid this progress, the rate of amputations rose 50% between 2009 and 2015. African American patients lose limbs at triple the rate of other groups.  The mission of the Affordable Care Act—spend more to prevent disease and complications, and save money later—has bypassed many of these patients for one reason: they lack access to care. Fourteen states have not expanded Medicaid, including several Deep South states where diabetes and obesity rates are highest. The result of these state-level policy decisions is becomi