title: A cross-jurisdictional evaluation of insurance coverage among HIV care patients following the Affordable Care Act.
abstract: The impact of the Affordable Care Act (ACA) on HIV care patients, aged 18-64, was evaluated in three jurisdictions with Medicaid expansion (Chicago, New York State, and Washington) and three jurisdictions without Medicaid expansion (Georgia, Texas, and Virginia) using data from the Medical Monitoring Project. Multivariate regression models were used to evaluate insurance status that was reported pre- and post-ACA; self-reported impact of ACA on HIV care was explored with descriptive statistics. The likelihood of having insurance was significantly greater post-ACA compared to pre-ACA in Chicago (aRR = 1.33, 95%CI = 1.20, 1.47), Washington (aRR = 1.15, 95%CI = 1.08, 1.22), and Virginia (aRR = 1.14, 95%CI = 1.00, 1.29). In Washington and Chicago, the likelihood of being Medicaid-insured was greater post-ACA compared to pre-ACA implementation (Chicago: aRR = 1.25, 95%CI = 1.03,1.53; Washington: aRR = 1.66 95% CI = 1.30, 2.13). No other significant differences were observed. Only a subset of HIV care patients (range: 15-35%) reported a change in insurance that would have coincided with the implementation of ACA; and within this subset, a change in medical care costs was the most commonly noted issue. In conclusion, the influence of ACA on insurance coverage and other factors affecting HIV care likely varies by jurisdiction.
authors.affiliation: a Public Health - Seattle & King County , HIV/STD Program , Seattle , WA , USA.|b Department of Epidemiology , University of Washington , Seattle , WA , USA.
authors.forename: Julia E
authors.initials: JE
authors.lastname: Hood
authors.affiliation: a Public Health - Seattle & King County , HIV/STD Program , Seattle , WA , USA.|b Department of Epidemiology , University of Washington , Seattle , WA , USA.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Buskin
authors.affiliation: c New York State Department of Health , AIDS Institute , Albany , NY , USA.
authors.forename: Bridget J
authors.initials: BJ
authors.lastname: Anderson
authors.affiliation: d Chicago Department of Public Health , Communicable Disease Program , Chicago , IL , USA.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Gagner
authors.affiliation: e Virginia Department of Health , Division of Disease Prevention , Richmond , VA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kienzle
authors.affiliation: f Georgia Department of Public Health , Division of Health Protection , Atlanta , GA , USA.
authors.forename: David
authors.initials: D
authors.lastname: Maggio
authors.affiliation: c New York State Department of Health , AIDS Institute , Albany , NY , USA.
authors.forename: Katie
authors.initials: K
authors.lastname: Markey
authors.affiliation: g Washington State Department of Health , Infectious Disease Assessment Unit , Tumwater , WA , USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Reuer
authors.affiliation: h Feinberg School of Medicine, Northwestern University , Chicago , IL , USA.
authors.forename: Nanette
authors.initials: N
authors.lastname: Benbow
authors.affiliation: f Georgia Department of Public Health , Division of Health Protection , Atlanta , GA , USA.
authors.forename: Pascale
authors.initials: P
authors.lastname: Wortley
mesh_terms: D000328:Adult; D002641:Chicago; D005260:Female; D005845:Georgia; D015658:HIV Infections / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D008875:Middle Aged; D009518:New York; D058991:Patient Protection and Affordable Care Act; D013781:Texas; D014481:United States; D014768:Virginia; D014861:Washington
keywords: HIV/AIDS; Ryan White; health reform; insurance coverage