Healthcare Coverage for HIV Provider Visits Before and After Implementation of the Affordable Care Act

Sa, Berry; Ja, Fleishman; Br, Yehia; Lw, Cheever; Hauck, Heather; Korthuis, P. Todd; Wc, Mathews; Keruly, Jeanne C.; Ae, Nijhawan; Al, Agwu; Somboonwit, Charurut; Rd, Moore; Gebo, KA

doi:10.1093/cid/ciw278

Cited by 19 publications

(18 citation statements)

References 17 publications

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“…The cost of PrEP also compares favorably with the cost of the CDC’s “Treatment as Prevention” (or Test and Treat) strategy (CDC, 2014b), which is widely adopted in the U.S. Following the implementation of the ACA, substantial reductions in the uninsured population and cost-savings to Ryan White could sustain funding for a PrEP program (Berry et al, 2016; Hood et al, 2017). This situation may change if the ACA is repealed and replaced, and Ryan White may become a resource of last resort for an increasing number of patients.…”

Section: Addressing Barriers To Prep Uptakementioning

confidence: 99%

Promoting Pre-exposure Prophylaxis to Prevent HIV Infections Among Sexual and Gender Minority Hispanics/Latinxs

Page

Martínez

Nieves-Lugo

et al. 2017

AIDS Education and Prevention

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Sexual and gender minority Hispanics/Latinxs (henceforth: Latinxs) continue to be disproportionately impacted by HIV/AIDS in the U.S. Pre-exposure prophylaxis (PrEP) is a biomedical prevention approach which holds significant promise for at risk and vulnerable populations. We discuss barriers and facilitators to uptake of PrEP among sexual and gender minority Latinxs living in the U.S. through an ecosocial lens that takes into account structural, community, and individual contexts. The impact of immigration status on PrEP uptake emerges as a major and recurrent theme that must be understood and addressed by HIV prevention programs aiming to promote an inclusive strategy for sexual and gender minority Latinxs living in the U.S.

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Section: Addressing Barriers To Prep Uptakementioning

confidence: 99%

Promoting Pre-exposure Prophylaxis to Prevent HIV Infections Among Sexual and Gender Minority Hispanics/Latinxs

Page

Martínez

Nieves-Lugo

et al. 2017

AIDS Education and Prevention

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“…4,11 Decreases in uninsured patients have also been noted at certain safety net providers, such as Federally Qualified Health Centers and clinics receiving Ryan White HIV/AIDS Program support. 12–14 Data from the National Health Information Survey showed little change between 2005 (18.9%) and 2013 (20.4%) in the percentage of nonelderly adults (18–64 years) without health insurance, and an almost 8-point drop between 2013 (20.4%) and 2015 (12.8%). 11 While we observed a substantial decrease in the percentage of Title X clients without health insurance, Title X clients remain uninsured at a higher rate compared with the national average (i.e., 48% of Title X clients were uninsured in 2015 compared with the national average of 12.8% for persons aged 18–64).…”

Section: Discussionmentioning

confidence: 99%

Trends in Health Insurance Coverage of Title X Family Planning Program Clients, 2005–2015

Decker

Ahrens

Fowler

et al. 2018

Journal of Women's Health

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“…Early evaluations suggest that some of these expectations have been met. A large multi-state study by the HIV Research Network found a decrease in Ryan White / uncompensated care in Medicaid expansion states post-ACA and a small increase in private coverage in non-expansion states [5]. Among PWH enrolled in a California health care system after ACA implementation, more new enrollees with HIV also had a primary care visit within six months of enrollment in 2014 compared with a cohort that enrolled in 2012, and rates of HIV viral control improved [6].…”

Section: Introductionmentioning

confidence: 99%

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

Satre¹,

Parthasarathy²,

Silverberg³

et al. 2020

Preprint

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Background: The Affordable Care Act (ACA) increased insurance coverage for people with HIV (PWH) in the United States, yet post-ACA health care utilization and HIV outcomes have rarely been examined. Methods: Among PWH newly enrolled in an integrated health care system (Kaiser Permanente Northern California) in 2014 (N=880), we examined use of health care and modeled associations between enrollment mechanisms (enrolled in a Qualified Health Plan through the California Exchange vs. other sources), deductibles (none, $1-$999 and >= $1000), receipt of benefits from the California AIDS Drug Assistance Program (ADAP), demographic factors, and three-year patterns of health service utilization (primary care, psychiatry, substance treatment, emergency, inpatient) and HIV outcomes (CD4 counts, viral suppression). Results: Health care use was greatest immediately after enrollment and decreased over three years. Those with high deductibles were less likely to use primary care (OR=0.64, 95% CI=0.49 - 0.83, p < 0.001) or psychiatry OR=0.58, 95% CI=0.36, 0.93, p=0.02) than those with low or no deductibles. Enrollment via the Exchange was associated with fewer psychiatry visits (rate ratio [RR]=0.38, 95% CI=0.17 - 0.83; p=0.02), but ADAP was positively associated with number of psychiatry visits (RR=2.22, 95% CI=1.22 – 4.05 p=0.01). There was no association between enrollment mechanism or deductibles and HIV outcomes, but ADAP enrollment was associated with viral suppression (OR=2.23, 95% CI=1.35 - 3.68, p<0.001). Non-white PWH were less likely to be virally suppressed, (OR=0.47, 95% CI= 0.31 - 0.71, p< 0.001). Conclusions: In this sample of PWH drawn from an integrated health care system in California, findings suggest that enrollment via the Exchange and higher deductibles were negatively associated with some aspects of service utilization but did not impact HIV outcomes; support from ADAP appeared to help patients achieve viral suppression; ethnic disparities remain important to address in post-ACA health services for PWH even among those with access to insurance coverage.

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Healthcare Coverage for HIV Provider Visits Before and After Implementation of the Affordable Care Act

Cited by 19 publications

References 17 publications

Promoting Pre-exposure Prophylaxis to Prevent HIV Infections Among Sexual and Gender Minority Hispanics/Latinxs

Promoting Pre-exposure Prophylaxis to Prevent HIV Infections Among Sexual and Gender Minority Hispanics/Latinxs

Trends in Health Insurance Coverage of Title X Family Planning Program Clients, 2005–2015

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

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