Evaluating the Impact of the Affordable Care Act on HIV Care, Outcomes, Prevention, and Disparities: A Critical Research Agenda

Abstract

In the United States (U.S.), health care policy plays a critical role in ensuring adequate care for people living with HIV (PLWH), eliminating new HIV infections, and reducing health disparities. The 2010 Patient Protection and Affordable Care Act (ACA) was designed to make health care more accessible, of higher quality, and more affordable. Many provisions of the ACA are considered relevant to HIV care and prevention. Because PLWH have unique care needs and many groups at risk for infection are members of vulnerable populations, timely and comprehensive evaluation of the ACA in terms of HIV is critical. In this paper, we discuss components of the ACA relevant to HIV care and prevention, describe their anticipated and initial effects, and finally, outline a research agenda to inform future HIV programming and policy.

Health care utilization and HIV clinical outcomes following Affordable Care Act implementation in California: A longitudinal study

“…Race/ethnic disparities in HIV care are a longstanding concern in the HIV treatment eld. It was hoped that disparities would be at least partially mitigated post-ACA [4,37], although recent data indicate that non-whites continue to have worse HIV care outcomes across multiple health care settings [38][39][40]. It is possible that factors associated with race/ethnicity and worse HIV outcomes but not measured in our study, such as health literacy [41] and variability in use of electronic provider communication tools [42,43] could have contributed to these differences.…”

“…We examined the effects of enrollment through the Exchange and deductible levels because these ACA features continue to be a major focus of policy in the U.S. Efforts were made on the part of some California health systems [6] and the Exchange itself [10] to educate new members (and potential members) on tiers of coverage and health care initiation processes. Although it is not known if other states made similar efforts, the Exchange in California represented a novel mechanism of coverage and entailed potential challenges both in determining how to choose coverage and sign up (pre-enrollment) and in understanding bene ts and services (post-enrollment) [4]. Our ndings that enrollment through the Exchange made no difference in accessing primary care or in HIV outcomes for newly enrolled PWH suggests that regardless of mechanism, new enrollees were able to access core services and achieve viral suppression.…”

“…Major components of the Affordable Care Act (ACA) [1] were introduced in 2014 to increase access to health insurance coverage in the U.S., particularly for vulnerable populations including people with HIV (PWH). It was expected that mandates of the ACA (e.g., establishment of state insurance exchanges, and inclusion of psychiatric and substance use treatment as essential bene ts) implemented in 2014 would increase health care utilization and quality, leading to improved behavioral health and HIV clinical outcomes [2][3][4].…”

Health care utilization and HIV clinical outcomes among newly enrolled patients following Affordable Care Act implementation in a California integrated health system: a longitudinal study

“…We examined the relationship of enrollment through the Exchange to outcomes because enrollment mechanisms are likely to remain a major focus of health care policy in the U.S. Efforts were made on the part of some California health systems [ 6 ] and the Exchange itself [ 10 ] to educate new members (and potential members) on tiers of coverage and health care initiation processes. Although it is not known if other states made similar efforts, the Exchange in California represented a novel mechanism of coverage and entailed potential challenges both in determining how to choose coverage and sign up (pre-enrollment) and in understanding benefits and services (post-enrollment) [ 4 ]. Our findings that enrollment through the Exchange made no difference in accessing primary care or in HIV outcomes for newly enrolled PWH suggests that regardless of mechanism, new enrollees were able to access core services.…”

“…Major components of the Affordable Care Act (ACA) [ 1 ] were introduced in 2014 to increase access to health insurance coverage in the U.S., particularly for vulnerable populations including people with HIV (PWH). It was expected that mandates of the ACA (e.g., establishment of state insurance exchanges, and inclusion of psychiatric and substance use treatment as essential benefits) implemented in 2014 would increase health care utilization and quality, leading to improved behavioral health and HIV clinical outcomes [ 2 – 4 ].…”