miércoles, 8 de junio de 2016

Healthcare Coverage for HIV Provider Visits before and after Implementation of the Affordable Care Act. - PubMed - NCBI

Healthcare Coverage for HIV Provider Visits before and after Implementation of the Affordable Care Act. - PubMed - NCBI



 2016 May 3. pii: ciw278. [Epub ahead of print]

Healthcare Coverage for HIV Provider Visits before and after Implementation of the Affordable Care Act.

Abstract

BACKGROUND:

 Prior to Affordable Care Act (ACA) implementation in 2014, 100,000 persons living with HIV (PLWH) lacked healthcarecoverage and relied on a safety net of Ryan White HIV/AIDS Program support, local charities, or uncompensated care (RWHAP/Uncomp) to covervisits to HIV providers. We compared HIV provider coverage pre (2011-2013) versus post (first half of 2014) ACA among a total of 28,374 PLWH followed in 4 sites in Medicaid expansion states (CA, OR, MD), 4 in a state (NY) that expanded Medicaid in 2001, and 2 in non-expansion states (TX, FL).

METHODS:

 Multivariate multinomial logistic models assessed changes in RWHAP/Uncomp, Medicaid, and private insurance coverage using Medicare as a referent.

RESULTS:

 In expansion state sites, RWHAP/Uncomp coverage decreased (unadjusted, 28% pre-ACA and 13% post-ACA; adjusted relative risk ratio (ARRR) 0.44 [0.40, 0.48]). Medicaid coverage increased (23% and 38%; ARRR 1.82 [1.70, 1.94]), and private coverage was unchanged (21% and 19%; ARRR 0.96 [0.89, 1.03]). In NY sites, both RWHAP/Uncomp (20% and 19%) and Medicaid (50% and 50%) were unchanged, while private decreased (13% and 12%; ARRR 0.86 [0.80, 0.92]). In non-expansion state sites, RWHAP/Uncomp (57% and 52%) and Medicaid (18% and 18%) were unchanged, while private increased (4% and 7%; ARRR 1.79 [1.62, 1.99]).

CONCLUSIONS:

 In expansion state sites, half of PLWH relying on RWHAP/Uncomp shifted to Medicaid, while in NY and non-expansion state sites, reliance on RWHAP/Uncomp remained constant. In the first half of 2014, the ACA did not eliminate the need for RWHAP safety net providervisit coverage.
© The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

PMID:
 
27143660
 
[PubMed - as supplied by publisher]

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