DAM exacts a large burden on American society. Therefore, improved diagnosis and management of community-based DAM to alleviate this burden are needed.

People are much less likely to engage in risky sexual behavior if they know that they are HIV-positive. Unfortunately, more than 18 percent of people living with HIV/AIDS in the United States are unaware of their HIV status, and about half of new HIV infections are transmitted from that "HIV unaware" population. For these reasons, HIV testing is at the forefront of HIV prevention strategies in the United States. The Affordable Care Act (ACA) may support these strategies, since gaining coverage increases the likelihood of being tested for HIV. We modeled the impact of the ACA on HIV testing, diagnoses, and awareness of being HIV-positive, assuming that only the eighteen states (and the District of Columbia) that had committed to expand Medicaid as of July 2013 did expand the program. We found that the ACA will result in an additional 466,153 people's being tested for HIV and 2,598 new diagnoses of HIV by 2017. Among people living with HIV/AIDS who gain insurance through the ACA, the share of the HIV unaware will decline by 22 percent. The impact on both HIV testing and new diagnoses would be nearly 30 percent larger if all fifty states expanded Medicaid. Policy makers should consider such epidemiological benefits when analyzing insurance expansion policies.

Disease-associated malnutrition (DAM) is a well-recognized problem in many countries, but the extent of its burden on the Chinese population is unclear. This article reports the results of a burden-of-illness study on DAM in 15 diseases in China. Using data from the World Health Organization (WHO), the China Health and Nutrition Survey, and the published literature, mortality and disability-adjusted life years (DALYs) lost because of DAM were calculated; a financial value of this burden was calculated following WHO guidelines. DALYs lost annually to DAM in China varied across diseases, from a low of 2248 in malaria to a high of 1 315 276 in chronic obstructive pulmonary disease. The total burden was 6.1 million DALYs, for an economic burden of US$66 billion (Chinese ¥ 447 billion) annually. This burden is sufficiently large to warrant immediate attention from public health officials and medical providers, especially given that low-cost and effective interventions are available.

ne e r aj s o o d z achary wagn er ya n y u wu A B S T R A C T This paper investigates the effects of health insurance on HIV testing rates among the US general population using nationally representative data from the Behavioral Risk Factor Surveillance Survey (BRFSS) for the years 1993 to 2003. We estimate recursive bivariate probit models with insurance coverage and HIV testing as the dependent variables. We use changes in Medicaid eligibility and distribution of firm size over time within a state as instruments for insurance coverage. The results suggest that (1) insurance coverage increases HIV testing rates, (2) insurance coverage increases HIV testing rates more among the high-risk population, and (3) the effects of insurance coverage on HIV testing for high-risk populations increased over time.

for helpful comments. Sood acknowledges funding from R01 grant # HD054877 from NICHD. Sood and Wu have no relevant material or financial relationships that bear on this research. The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research. NBER working papers are circulated for discussion and comment purposes. They have not been peerreviewed or been subject to the review by the NBER Board of Directors that accompanies official NBER publications.