50-State Budget Survey for FY 2014
The U.S. spends an estimated $245 billion annually as a result of diabetes. This report explains how diabetes accounts for more than 6 percent of total health spending, and provides specific dollar figures for state legislative and other governmental appropriations to states to treat and prevent diabetes.
Diabetes is a disease that is characterized by higher than normal levels of glucose in one’s blood. Insulin is the substance that allows glucose to be transported to cells. When a person’s pancreas does not produce adequate insulin to allow cells to absorb glucose, or cells become resistant to glucose, the total levels of glucose in the blood increase. Currently, there is no cure for diabetes. The condition manifests in several ways, as Type 1 or Type 2 diabetes, gestational diabetes, as well as the condition.
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Overview of the Costs Associated with Diabetes
Diabetes is associated with a host of health problems. In particular, Type 2 diabetes is associated with overweight and obesity, hypertension and stroke, heart disease, kidney disorders, amputations and other problems. Type 2 diabetes is the leading cause of acquired blindness and is one of the leading causes of death in the US.[i]
According the U.S. government’s National Diabetes Education Program, 25.8 million Americans have diabetes—8.3 percent of the U.S. population. Of these, 7 million do not know they have the disease.[ii] It is estimated that another 79 million adults aged 20 and older have prediabetes.[iii] Prediabetes is a condition where blood glucose levels are higher than normal but not high enough to be called diabetes.
The financial impact of diabetes on America rose to $245 billion in 2012, $27 billion more than in 2007. $176 billion of that is attributed to direct costs associated with diabetes.[iv] Direct costs include the medical costs involved with treating diabetes.[v] Indirect costs associated with diabetes include, but are not limited to, lost productivity and missed days at work, physical disability and premature death.[vi]
State Legislative Responses to Diabetes | Programs and Budget Appropriations
States have recently enacted a number of laws and programs related to controlling and preventing diabetes:
Diabetes Prevention and Screening Coverage for State Employees: Colorado, Kentucky and Washington recently began coverage of diabetes prevention and screening services for those with prediabetes for all employees and dependents insured in their state employee health insurance systems.
Diabetes Action Plans: Today, more than 15 states have laws requiring state Medicaid programs, state employee health programs and public programs to biennially assess the medical and financial impact of diabetes on the programs and propose solutions for legislatures to consider implementing to control the epidemic. States requiring action plans include Arkansas, Florida, Illinois, Kentucky, Louisiana, Mississippi, Missouri New Jersey, North Carolina, North Dakota, Oklahoma (added 2015), Oregon, Tennessee, Texas, Washington and Wyoming. [i]
Focus on the Budget Impact of Gestational Diabetes and Diabetes During Pregnancy on State Medicaid Programs: Texas recently published a report on the increasing prevalence of diabetes during pregnancy and the impact of all forms of diabetes during pregnancy on a developing child and state health programs. The report has since been cited frequently by diabetes researchers.
Coverage of Diabetes Self-Management Training by Medicaid Programs: Colorado and Mississippi adopted measures directing their Medicaid programs to cover diabetes self-management training services for Medicaid enrollees diagnosed with diabetes.
Diabetes Awareness Activities: Louisiana and Tennessee passed laws in 2014 that authorize the use of license plates for this purpose, increasing visibility for the general public and earmarking revenue to support in-state programs. Illinois, North Carolina, and Tennessee passed similar laws in 2013.
Protecting the Health and Interests of Children with Diabetes and Families During School Hours: Alabama, Ohio and Tennessee passed laws in 2014 that allow school personnel to administer medication to diabetic students. Kentucky and Virginia passed laws allowing students to treat and manage their diabetes while attending school.
Obesity Prevention Activities: Hawaii passed laws in 2013 to encourage residents to consume fresh, locally produced foods and to encourage breastfeeding in an effort to improve the diets of Hawaiians.
Details by State: Appropriations for FY 2014
Twenty states, the District of Columbia and Puerto Rico appropriated funds for diabetes in fiscal year 2014. Consistent with typical state budget approaches, reported funds include “State, Federal, Special, and Other Dollars Appropriated by State Legislatures Specifically for Diabetes.” Earmarked state-only funds (in 11 states) are identified as such in a separate column in Table 1 (page 8). State explanations include one or more legislative citations in the form used by the state: (Year, often the first of a two-year session and a House (H) or Senate (S) bill number). This report reflects final enacted appropriations, which may not reflect actual spending by state governments.
Four states—Montana, Nevada, North Dakota and Texas—did not have a regular legislative session in 2014.
Notes on State Budget Processes
In 46 states, the 2014 budget fiscal year began July 1, 2013, and ended June 30, 2014. The exceptions are New York (April 1), Texas (September 1), and Alabama and Michigan (October 1). In some cases, state agencies or grantees are permitted to carry over or continue spending into the following fiscal year. Figures reported in this publication are taken from the enacted or final approved budgets at the start of the fiscal year. Many states include and adopt appropriations of both federal and state money. Table 1 separates the source of diabetes funds wherever possible.
Connecticut, Hawaii, Indiana, Maine, Minnesota, Montana, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oregon, Texas, Washington and Wisconsin passed their FY 2014 budgets as part of a two-year cycle.
Notes on State Data
The data provided should not be interpreted as a comprehensive spending reference for the state as a whole, since data presented includes only funds specifically designated in the state budget via the legislature for diabetes-focused actions. In addition, the term “other” is used to describe funds appropriated by the legislature where the origins of a revenue source were not apparent in the budget. Medicaid spending on diabetes usually is not included in this report because the funds are combined with other provider services and reimbursements.
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[i] Centers for Disease Control and Prevention, Leading Causes of Death, 2013
[ii] National Diabetes Education Program (NDEP) is a partnership of the National Institutes of Health, the Centers for Disease Control and Prevention, and more than 200 public and private organizations.
[iii] The Facts About Diabetes: A Leading Cause of Death in the U.S.,
[iv] American Diabetes Association, The Cost of Diabetes, 2013
[v]State Diabetes Action Plans: News from the Field May 2015, National Association of Chronic Disease Directors.
About the author: Ashley Noble, Pollicy Specialist, NCSL Health Program