title: AIDS Drug Assistance Programs: managers confront uncertainty and need to adapt as the Affordable Care Act kicks in.
abstract: With the Affordable Care Act set to expand insurance coverage to millions more Americans next year, existing discretionary health programs that receive federal support might find themselves competing for funds as the health reform law is fully implemented. To assess the implications the Affordable Care Act might have for discretionary health programs, we focused on state AIDS Drug Assistance Programs, which provide free medications to low-income HIV patients. We conducted semistructured interviews with program managers from twenty-two states. Many of the managers predicted that their programs will change focus to provide "wrap-around services," such as helping newly insured clients finance out-of-pocket expenses, including copayments, deductibles, and premiums. Although program managers acknowledged that they must adapt to a changing environment, many said that they were overwhelmed by the complexity of the Affordable Care Act, and some expressed fear that state AIDS Drug Assistance Programs would be eliminated entirely. To remain viable, such programs must identify and justify the need for services in the context of the Affordable Care Act and receive sufficient political support and funding.
authors.affiliation: Rockefeller College of Public Affairs and Policy, University at Albany, State University of New York, New York, NY, USA. emartin@albany.edu
authors.forename: Erika G
authors.initials: EG
authors.lastname: Martin
authors.forename: Terence
authors.initials: T
authors.lastname: Meehan
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Schackman
mesh_terms: D019380:Anti-HIV Agents / Q000191:economics* / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D005380:Financing, Government / Q000191:economics / Q000331:legislation & jurisprudence* / Q000639:trends; D015658:HIV Infections / Q000188:drug therapy / Q000191:economics*; D019538:Health Care Surveys; D006284:Health Plan Implementation / Q000191:economics / Q000331:legislation & jurisprudence; D006297:Health Services Accessibility / Q000191:economics / Q000331:legislation & jurisprudence*; D006801:Humans; D019458:Insurance Coverage / Q000191:economics / Q000331:legislation & jurisprudence; D007348:Insurance, Health / Q000191:economics / Q000331:legislation & jurisprudence; D007407:Interviews as Topic; D008483:Medical Assistance / Q000191:economics / Q000331:legislation & jurisprudence*; D058991:Patient Protection and Affordable Care Act / Q000191:economics*; D013219:State Government; D035501:Uncertainty; D014481:United States
chemical_list: D019380:Anti-HIV Agents
keywords: AIDS Drug Assistance Programs; AIDS/HIV; Health Reform; Organization And Delivery Of Care