The Affordable Care Act (ACA), fully implemented in 2014, expanded health care coverage options for many people living with HIV in the U.S. It is unknown how health coverage among persons in HIV medical care has changed since ACA implementation and how such changes may be associated with prevalence of viral suppression.
We used 2012 and 2014 data from the Medical Monitoring Project (MMP) to examine pre- and post-ACA implementation changes in health care coverage types and viral suppression among adults receiving HIV medical care. MMP is a surveillance system utilizing a national probability sample of adults receiving HIV care in the U.S. We computed weighted percentages of adults who were uninsured or had private, Medicaid, or Medicare coverage in each time period. We also assessed, in each time period, the percentage of adults receiving Ryan White HIV/AIDS Program services for low-income, un- and under-insured persons, and the percentage of persons virally suppressed (<200 copies/mL) at last test. All analyses were stratified by residence in a Medicaid vs. non-Medicaid-expansion (ME vs. NME) state, defined as expansion anytime in 2014.
In 2012, 26% [95% confidence interval (CI): 20–31] of persons in HIV medical care were uninsured in NME states compared to 13% (CI: 10–16) in ME states. There was no change in health care coverage of persons receiving HIV care in NME states from 2012–2014. In ME states, the percentage uninsured declined from 13% to 7% (CI: 6–8), and Medicaid coverage increased from 39% (CI: 32–46) to 51% (CI: 46–56). The percentage of patients receiving Ryan White services was 42% (CI: 39–45) in both NME and ME expansion states in 2012 but increased to 55% (CI: 49–62) in NME states in 2014 with no accompanying change in ME states. Prevalence of viral suppression was 77% (CI: 75–79) in both NME and ME states in 2012, increasing to 83% (CI: 81–85) among patients in ME states and non-significantly to 81% among patients in NME states (CI: 76–86) in 2014.
Among patients in ME states, the percentage of persons in HIV care who were uninsured declined by nearly 50% from 2012–2014; this was driven by increases in Medicaid coverage. No decline in the percentage uninsured was found among patients in NME states. Viral suppression increased by 8% in ME states from 2012–2014. Future work will examine whether this increase in viral suppression is attributable to changes in health care coverage.