A cross-jurisdictional evaluation of insurance coverage among HIV care patients following the Affordable Care Act

被引:5
|
作者
Hood, Julia E. [1 ,2 ]
Buskin, Susan E. [1 ,2 ]
Anderson, Bridget J. [3 ]
Gagner, Alexandra [4 ]
Kienzle, Jennifer [5 ]
Maggio, David [6 ]
Markey, Katie [3 ]
Reuer, Jennifer [7 ]
Benbow, Nanette [8 ]
Wortley, Pascale [6 ]
机构
[1] Publ Hlth Seattle & King Cty, HIV STD Program, 401 5th Ave,Suite 1152, Seattle, WA 98104 USA
[2] Univ Washington, Dept Epidemiol, Seattle, WA 98195 USA
[3] New York State Dept Hlth, AIDS Inst, Albany, NY USA
[4] Chicago Dept Publ Hlth, Communicable Dis Program, Chicago, IL USA
[5] Virginia Dept Hlth, Div Dis Prevent, Richmond, VA USA
[6] Georgia Dept Publ Hlth, Div Hlth Protect, Atlanta, GA USA
[7] Washington State Dept Hlth, Infect Dis Assessment Unit, Tumwater, WA USA
[8] Northwestern Univ, Feinberg Sch Med, Chicago, IL 60611 USA
关键词
HIV/AIDS; health reform; Ryan White; insurance coverage;
D O I
10.1080/09540121.2016.1222055
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
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.
引用
收藏
页码:511 / 515
页数:5
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