Aaron: An update on the Affordable Care Act and some more bad news for believers in the power of taking Vitamin D.  This is Healthcare Triage News. 

(Intro)

First story is an update on the Affordable Care Act.  I've long argued that the ACA is all about access.  It was designed primarily to reduce the number of uninsured in the United States.  We can argue about its effects on quality and cost, but it was willing to spend money to reduce the number of people in the United States who lack health insurance.

Somehow, this is still controversial.  Regardless, the data show that with respect to its primary metric, it's succeeding.  Gallup reports that the uninsured rate has dropped from 17.3% in 2013 to 11.7% in the first half of 2015.  Moreover, states that have embraced the law more fully have seen greater reductions, this is like a dose response.  Here's a chart I made from Gallup data on how the uninsured rate changed among states who adopted both the Medicaid expansion and set up their own exchange, versus states who did one of those things or neither of them.  The states which adopted both saw the uninsured rate drop an absolute 7.1% and a relative 44%, the states that did one or neither saw the uninsured rate drop only an absolute 5.3% or a relative 28%.  So even though states that implemented both the Medicaid expansion and state exchanges had a lower uninsured rate to begin with, they still saw absolute greater reductions than states that did one or neither. 

Additionally, the seven states that saw the biggest drops in the rate of uninsured were states that adopted both.  The top two states were Arkansas, 22.5% to 9.1%, and Kentucky, 20.4% to 9%.  Both are pretty red states.

Next up, our old friend, Vitamin D.  From JAMA Internal Medicine, "Treatment of Vitamin D insufficiency in post-menopausal women, a randomized controlled trial."  This was an RCT of Vitamin D supplementation in 230 postmenopausal women 75 years of age or younger, who had diagnosed Vitamin D deficiency, but no osteoporosis yet.  Seems like this is a population where Vitamin D supplementation would work.

There were three arms: placebo, low-dose supplementation, and high-dose supplementation, and women were followed for a year.  Ready for the results?  In the high-dose arm, calcium absorption went up 1%.  It went down 1.3% in the placebo arm.  It also went down more, or 2%, in the low-dose arm.  So, I don't know.  And in other results?  There was no impact in spine, mean total hip, mean femoral neck, or total body bone mineral density.  There was no effect on trabecular bone score.  No effect on muscle mass.  No effect on functional tests.  There were no changes in falls, the number of people who fell, physical activity, or even functional status. 

If supplementation with a vitamin for an actual deficiency of that vitamin has no impact on bone measurements and outcomes, then what's the point?  Maybe deficiency doesn't mean what we think it does.  Giving people the supplement seems to make no sense.  I'm baffled.

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