Assessing the Impact of the Affordable Care Act on Health Insurance Coverage of People with HIV

The Affordable Care Act (ACA), signed into law in 2010, is expected to expand insurance coverage for millions of people in the United States, including people with HIV infection.  While several provisions of the ACA have implications for people with HIV, two are expected to have the most far reaching effects on coverage – the expansion of Medicaid eligibility and the creation of new Health Insurance Marketplaces where individuals can purchase private coverage. This issue brief, based on analysis of nationally representative data from the Centers for Disease Control and Prevention’s (CDC’s) Medical Monitoring Project (MMP), provides the first national estimates of how many people with HIV who are receiving medical care may gain new insurance coverage due to the ACA through both Medicaid expansion and the state Marketplaces.  It finds that of the approximately 407,000 people with HIV between the ages of 19-64 in care, most (87%) have incomes below 400% FPL. While Medicaid is their single largest source of coverage (covering about 4 in 10), close to 70,000 (17%) are currently uninsured. Of these, almost 23,000 would gain coverage through the Marketplace (most of whom would be eligible for financial assistance), and approximately 46,910 would be eligible for Medicaid, if all states were to expand Medicaid. However, only 26 states plan to expand their Medicaid programs as of October 2013, which could reduce the number gaining coverage through Medicaid expansion by more than 40%. For individuals left out of coverage expansions, the Ryan White HIV/AIDS Program will continue to be critical; it will also likely continue to remain critical in filling the gaps in insurance coverage for HIV care for many insured people with HIV, as it does today. Lastly, while this analysis focuses on the approximately 407,000 people with HIV between the ages of 19-64 who are already in care, more than 700,000 people with HIV are not yet in care.  Based on the findings presented here, an additional 124,000 could gain new coverage due to the ACA, removing one obstacle to care seeking and bringing the total estimated number of people with HIV who could gain new coverage close to 200,000.