Healthcare Coverage for HIV Provider Visits before and after Implementation of the Affordable Care Act

HIV Research Network

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background. Before implementation of the Patient Protection and Affordable Care Act (ACA) in 2014, 100 000 persons living with human immunodeficiency virus (HIV) (PLWH) lacked healthcare coverage and relied on a safety net of Ryan White HIV/AIDS Program support, local charities, or uncompensated care (RWHAP/Uncomp) to cover visits to HIV providers. We compared HIV provider coverage before (2011-2013) versus after (first half of 2014) ACA implementation among a total of 28 374 PLWH followed up in 4 sites in Medicaid expansion states (California, Oregon, and Maryland), 4 in a state (New York) that expanded Medicaid in 2001, and 2 in nonexpansion states (Texas and Florida). Methods. Multivariate multinomial logistic models were used to assess changes in RWHAP/Uncomp, Medicaid, and private insurance coverage, using Medicare as a referent. Results. In expansion state sites, RWHAP/Uncomp coverage decreased (unadjusted, 28% before and 13% after ACA; adjusted relative risk ratio [ARRR], 0.44; 95% confidence interval [CI],. 40-.48). Medicaid coverage increased (23% and 38%; ARRR, 1.82; 95% CI, 1.70-1.94), and private coverage was unchanged (21% and 19%; 0.96;. 89-1.03). In New York sites, both RWHAP/Uncomp (20% and 19%) and Medicaid (50% and 50%) coverage were unchanged, while private coverage decreased (13% and 12%; ARRR, 0.86; 95% CI,. 80-.92). In nonexpansion state sites, RWHAP/Uncomp (57% and 52%) and Medicaid (18% and 18%) coverage were unchanged, while private coverage increased (4% and 7%; ARRR, 1.79; 95% CI, 1.62-1.99). Conclusions. In expansion state sites, half of PLWH relying on RWHAP/Uncomp coverage shifted to Medicaid, while in New York and nonexpansion state sites, reliance on RWHAP/Uncomp remained constant. In the first half of 2014, the ACA did not eliminate the need for RWHAP safety net provider visit coverage.

Original languageEnglish (US)
Pages (from-to)387-395
Number of pages9
JournalClinical Infectious Diseases
Volume63
Issue number3
DOIs
StatePublished - Aug 1 2016

Fingerprint

Patient Protection and Affordable Care Act
Medicaid
HIV
Delivery of Health Care
Odds Ratio
Confidence Intervals
Safety-net Providers
Uncompensated Care
Charities
Insurance Coverage
Medicare
Acquired Immunodeficiency Syndrome
Logistic Models
Safety

Keywords

  • Affordable Care Act
  • HIV
  • insurance
  • Medicaid
  • Ryan White HIV/AIDS Program

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Healthcare Coverage for HIV Provider Visits before and after Implementation of the Affordable Care Act. / HIV Research Network.

In: Clinical Infectious Diseases, Vol. 63, No. 3, 01.08.2016, p. 387-395.

Research output: Contribution to journalArticle

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title = "Healthcare Coverage for HIV Provider Visits before and after Implementation of the Affordable Care Act",
abstract = "Background. Before implementation of the Patient Protection and Affordable Care Act (ACA) in 2014, 100 000 persons living with human immunodeficiency virus (HIV) (PLWH) lacked healthcare coverage and relied on a safety net of Ryan White HIV/AIDS Program support, local charities, or uncompensated care (RWHAP/Uncomp) to cover visits to HIV providers. We compared HIV provider coverage before (2011-2013) versus after (first half of 2014) ACA implementation among a total of 28 374 PLWH followed up in 4 sites in Medicaid expansion states (California, Oregon, and Maryland), 4 in a state (New York) that expanded Medicaid in 2001, and 2 in nonexpansion states (Texas and Florida). Methods. Multivariate multinomial logistic models were used to assess changes in RWHAP/Uncomp, Medicaid, and private insurance coverage, using Medicare as a referent. Results. In expansion state sites, RWHAP/Uncomp coverage decreased (unadjusted, 28{\%} before and 13{\%} after ACA; adjusted relative risk ratio [ARRR], 0.44; 95{\%} confidence interval [CI],. 40-.48). Medicaid coverage increased (23{\%} and 38{\%}; ARRR, 1.82; 95{\%} CI, 1.70-1.94), and private coverage was unchanged (21{\%} and 19{\%}; 0.96;. 89-1.03). In New York sites, both RWHAP/Uncomp (20{\%} and 19{\%}) and Medicaid (50{\%} and 50{\%}) coverage were unchanged, while private coverage decreased (13{\%} and 12{\%}; ARRR, 0.86; 95{\%} CI,. 80-.92). In nonexpansion state sites, RWHAP/Uncomp (57{\%} and 52{\%}) and Medicaid (18{\%} and 18{\%}) coverage were unchanged, while private coverage increased (4{\%} and 7{\%}; ARRR, 1.79; 95{\%} CI, 1.62-1.99). Conclusions. In expansion state sites, half of PLWH relying on RWHAP/Uncomp coverage shifted to Medicaid, while in New York and nonexpansion state sites, reliance on RWHAP/Uncomp remained constant. In the first half of 2014, the ACA did not eliminate the need for RWHAP safety net provider visit coverage.",
keywords = "Affordable Care Act, HIV, insurance, Medicaid, Ryan White HIV/AIDS Program",
author = "{HIV Research Network} and Berry, {Stephen A.} and Fleishman, {John A.} and Yehia, {Baligh R.} and Cheever, {Laura W.} and Heather Hauck and Korthuis, {P. Todd} and Mathews, {W. Christopher} and Jeanne Keruly and Nijhawan, {Ank E.} and Agwu, {Allison L.} and Charurut Somboonwit and Moore, {Richard D.} and Gebo, {Kelly A.} and Howard Edelstein and Richard Rutstein and Jeffrey Jacobson and Sara Allen and Stephen Boswell and Beil, {Robert S.} and Felsen, {Uriel R.} and Muhammad Akbar and Aditya Gaur and Judith Aberg and Antonio Urbina and Roberto Corales and Fred Hellinger and Irene Fraser and Robert Mills and Faye Malitz and Cindy Voss and Nikki Balding",
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T1 - Healthcare Coverage for HIV Provider Visits before and after Implementation of the Affordable Care Act

AU - HIV Research Network

AU - Berry, Stephen A.

AU - Fleishman, John A.

AU - Yehia, Baligh R.

AU - Cheever, Laura W.

AU - Hauck, Heather

AU - Korthuis, P. Todd

AU - Mathews, W. Christopher

AU - Keruly, Jeanne

AU - Nijhawan, Ank E.

AU - Agwu, Allison L.

AU - Somboonwit, Charurut

AU - Moore, Richard D.

AU - Gebo, Kelly A.

AU - Edelstein, Howard

AU - Rutstein, Richard

AU - Jacobson, Jeffrey

AU - Allen, Sara

AU - Boswell, Stephen

AU - Beil, Robert S.

AU - Felsen, Uriel R.

AU - Akbar, Muhammad

AU - Gaur, Aditya

AU - Aberg, Judith

AU - Urbina, Antonio

AU - Corales, Roberto

AU - Hellinger, Fred

AU - Fraser, Irene

AU - Mills, Robert

AU - Malitz, Faye

AU - Voss, Cindy

AU - Balding, Nikki

PY - 2016/8/1

Y1 - 2016/8/1

N2 - Background. Before implementation of the Patient Protection and Affordable Care Act (ACA) in 2014, 100 000 persons living with human immunodeficiency virus (HIV) (PLWH) lacked healthcare coverage and relied on a safety net of Ryan White HIV/AIDS Program support, local charities, or uncompensated care (RWHAP/Uncomp) to cover visits to HIV providers. We compared HIV provider coverage before (2011-2013) versus after (first half of 2014) ACA implementation among a total of 28 374 PLWH followed up in 4 sites in Medicaid expansion states (California, Oregon, and Maryland), 4 in a state (New York) that expanded Medicaid in 2001, and 2 in nonexpansion states (Texas and Florida). Methods. Multivariate multinomial logistic models were used to assess changes in RWHAP/Uncomp, Medicaid, and private insurance coverage, using Medicare as a referent. Results. In expansion state sites, RWHAP/Uncomp coverage decreased (unadjusted, 28% before and 13% after ACA; adjusted relative risk ratio [ARRR], 0.44; 95% confidence interval [CI],. 40-.48). Medicaid coverage increased (23% and 38%; ARRR, 1.82; 95% CI, 1.70-1.94), and private coverage was unchanged (21% and 19%; 0.96;. 89-1.03). In New York sites, both RWHAP/Uncomp (20% and 19%) and Medicaid (50% and 50%) coverage were unchanged, while private coverage decreased (13% and 12%; ARRR, 0.86; 95% CI,. 80-.92). In nonexpansion state sites, RWHAP/Uncomp (57% and 52%) and Medicaid (18% and 18%) coverage were unchanged, while private coverage increased (4% and 7%; ARRR, 1.79; 95% CI, 1.62-1.99). Conclusions. In expansion state sites, half of PLWH relying on RWHAP/Uncomp coverage shifted to Medicaid, while in New York and nonexpansion state sites, reliance on RWHAP/Uncomp remained constant. In the first half of 2014, the ACA did not eliminate the need for RWHAP safety net provider visit coverage.

AB - Background. Before implementation of the Patient Protection and Affordable Care Act (ACA) in 2014, 100 000 persons living with human immunodeficiency virus (HIV) (PLWH) lacked healthcare coverage and relied on a safety net of Ryan White HIV/AIDS Program support, local charities, or uncompensated care (RWHAP/Uncomp) to cover visits to HIV providers. We compared HIV provider coverage before (2011-2013) versus after (first half of 2014) ACA implementation among a total of 28 374 PLWH followed up in 4 sites in Medicaid expansion states (California, Oregon, and Maryland), 4 in a state (New York) that expanded Medicaid in 2001, and 2 in nonexpansion states (Texas and Florida). Methods. Multivariate multinomial logistic models were used to assess changes in RWHAP/Uncomp, Medicaid, and private insurance coverage, using Medicare as a referent. Results. In expansion state sites, RWHAP/Uncomp coverage decreased (unadjusted, 28% before and 13% after ACA; adjusted relative risk ratio [ARRR], 0.44; 95% confidence interval [CI],. 40-.48). Medicaid coverage increased (23% and 38%; ARRR, 1.82; 95% CI, 1.70-1.94), and private coverage was unchanged (21% and 19%; 0.96;. 89-1.03). In New York sites, both RWHAP/Uncomp (20% and 19%) and Medicaid (50% and 50%) coverage were unchanged, while private coverage decreased (13% and 12%; ARRR, 0.86; 95% CI,. 80-.92). In nonexpansion state sites, RWHAP/Uncomp (57% and 52%) and Medicaid (18% and 18%) coverage were unchanged, while private coverage increased (4% and 7%; ARRR, 1.79; 95% CI, 1.62-1.99). Conclusions. In expansion state sites, half of PLWH relying on RWHAP/Uncomp coverage shifted to Medicaid, while in New York and nonexpansion state sites, reliance on RWHAP/Uncomp remained constant. In the first half of 2014, the ACA did not eliminate the need for RWHAP safety net provider visit coverage.

KW - Affordable Care Act

KW - HIV

KW - insurance

KW - Medicaid

KW - Ryan White HIV/AIDS Program

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U2 - 10.1093/cid/ciw278

DO - 10.1093/cid/ciw278

M3 - Article

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VL - 63

SP - 387

EP - 395

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

SN - 1058-4838

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