Assessing the Impact of the Affordable Care Act on Health Insurance Coverage of People with HIV
For a comprehensive overview of the provisions of the ACA that are of particular importance to people with HIV, see: Crowley J, Kates J (2012), The Affordable Care Act, the Supreme Court, and HIV: What Are the Implications? Washington, DC: Kaiser Family Foundation. Available at: http://kff.org/health-reform/report/the-affordable-care-act-the-supreme-court-and-hiv-what-are-the-implications/.
An analysis conducted by the Center for Health Law and Policy Innovation at Harvard Law School and the Treatment Access Expansion Project used data from the Ryan White AIDS Drug Assistance Program to estimate the number of ADAP clients who might be newly eligible for coverage by state. See: Estimating the Transition of People Living with HIV/AIDS to Medicaid or Subsidized Private Health Insurance through the Patient Protection and Affordable Care Act, 2012.
Hall H, Frazier EL, Rhodes P, et al. (2013). “Differences in Human Immunodeficiency Virus Care and Treatment Among Subpopulations in the United States.” JAMA Intern Med. 173(14):1337-1344.
Kates J (2011), Medicaid and HIV: A National Analysis. Washington, DC: Kaiser Family Foundation. Available at: http://kff.org/hivaids/report/medicaid-and-hiv-a-national-analysis/.
Department of Health and Human Services, Panel on Antiretroviral Guidelines for Adults and Adolescents (2013). Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents, February 12, 2013. Available at: http://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-treatment-guidelines/0/.
For a list of these states and their eligibility requirements, see Kaiser Family Foundation, State Health Facts, “Adult Income Eligibility Limits at Application as a Percent of the Federal Poverty Level (FPL), January 2013”. Available at: http://kff.org/medicaid/state-indicator/income-eligibility-low-income-adults/.
KFF analysis of data from the CDC NCHHSTP Atlas on the number of people living with an HIV diagnosis by state. See: http://gis.cdc.gov/GRASP/NCHHSTPAtlas/main.html.
For a list of the current status of state Medicaid expansion decisions, see Kaiser Family Foundation, State Health Facts, “Status of State Action on the Medicaid Expansion Decision, as of September 16, 2013”. Available at: http://kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/
Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on the Census Bureau's March 2012 Current Population Survey (CPS: Annual Social and Economic Supplements).
Holahan J, Buettgens M, Carroll C, Dorn S. The Cost and Coverage Implications of the ACA Medicaid Expansion: National and State-by-State Analysis. (Washington, DC: The Kaiser Commission on Medicaid and the Uninsured), November 2012. Available at: http://www.kff.org/health-reform/report/the-cost-and-coverage-implications-of-the/.
Congressional Budget Office. Effects on Health Insurance and the Federal Budget for the Insurance Coverage Provisions in the Affordable Care Act—May 2013 Baseline. Available at: http://www.cbo.gov/publication/44190.
KCMU and Urban Institute estimates based on data from FY 2010 MSIS and CMS-64 reports, available at http://www.kff.org/hivaids/state-indicator/enrollment-spending-on-hiv/.
IOM (Institute of Medicine). 2012. Monitoring HIV care in the United States: A strategy for generating national estimates of HIV care and coverage. Washington, DC: The National Academies Press.
CDC Medical Monitoring Project (MMP): http://www.cdc.gov/hiv/prevention/ongoing/mmp/index.html.
McNaghten, Wolfe et al. 2007; Blair, McNaghten et al. 2011; Frankel, McNaghten et al. 2012.
Analysis of data from Centers for Disease Control and Prevention, HIV Surveillance Report, 2011; vol. 23. http://www.cdc.gov/hiv/topics/surveillance/resources/reports/. Published February 2013..
Current Medicaid eligibility extends through age 18 (and in some states, through age 20), and Medicare covers most people starting at age 65; thus, in examining new coverage options available to adults, we focus on the population age 19 through 64.
For more information on the Medicaid undercount, see: http://www.census.gov/did/www/snacc/.
also of interest
- Health Affairs Blog: The ACA And People With HIV: The ACA’s Impact And The Implications Of State Choices
- The Uninsured: An Interactive Tool
- Implications of the Affordable Care Act for People With HIV Infection and the Ryan White HIV/AIDS Program: What Does the Future Hold?
- Helping People With HIV Navigate the Transition to ACA Coverage: Summary of a Roundtable Discussion