Current and (Potential) Future Effects of the Affordable Care Act on HIV Prevention

Viall, Abigail H.; McCray, Eugene; Mermin, Jonathan; Wortley, Pascale M.

doi:10.1007/s11904-016-0306-z

Cited by 12 publications

(8 citation statements)

References 32 publications

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“…Under the Affordable Care Act, routine preventive care, including HIV preventative care, is required to be covered as an "essential health benefit" for nongrandfathered private plans and Medicaid expansion programs, making it possible that testing now occurs more frequently for this population. 26,27 Not surprisingly, state-level resources from CDC prevention funding were also associated with more frequent HIV testing. Communities receiving more CDC prevention funding have higher levels of HIV prevalence, 20 and may also have a health care workforce that is more aware of HIV and thereby more likely to order HIV testing than a workforce with lower levels of HIV awareness.…”

Section: Discussionmentioning

confidence: 99%

Examining the Impact of State-Level Factors on HIV Testing for Medicaid Enrollees With Schizophrenia

Thomas

Vittinghoff

Koester

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: People with schizophrenia experience unique barriers to routine HIV testing, despite increased risk of HIV compared with the general US population. Little is known about how health care delivery system factors affect testing rates or whether there are testing differences for people with schizophrenia. Setting: Nationally representative sample of Medicaid enrollees with and without schizophrenia. Methods: Using retrospective longitudinal data, we examined whether state-level factors were associated with differences in HIV testing among Medicaid enrollees with schizophrenia compared with frequency-matched controls during 2002–2012. Multivariable logistic regression estimated testing rate differences between and within cohorts. Results: Higher HIV testing rates for enrollees with schizophrenia were associated with higher state-level Medicaid spending per enrollee, efforts to reduce Medicaid fragmentation, and higher federal prevention funding. State-level AIDS epidemiology predicted more frequent HIV testing for enrollees with schizophrenia versus controls. Living in rural settings predicted lower HIV testing, especially for people with schizophrenia. Conclusion: Overall, state-level predictors of HIV testing rates varied among Medicaid enrollees, although rates were generally higher for those with schizophrenia than controls. Increased HIV testing for people with schizophrenia was associated with coverage of HIV testing when medically necessary, higher Centers for Disease Control and Prevention prevention funding, and higher AIDS incidence, prevalence, and mortality when compared with controls. This analysis suggests that state policymaking has an important role to play in advancing that effort. Overcoming fragmented care systems, sustaining robust prevention funding, and consolidating funding streams in innovative and flexible ways to support more comprehensive systems of care delivery deserve attention.

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Section: Discussionmentioning

confidence: 99%

Examining the Impact of State-Level Factors on HIV Testing for Medicaid Enrollees With Schizophrenia

Thomas

Vittinghoff

Koester

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…We do not yet know, but signs such as focus on the repeal of the Affordable Care Act (and possible scaling back of Medicaid funding) are troubling for everyone and acutely so for persons living with HIV; such actions could lead to lack of coverage for needed services, disruption in care systems, and place a strain on the ever-important safety net services provided under the Ryan White Care Act (especially its AIDS Drug Assistance Program provisions). [17,18] Many segments of society have a role to play to ensure that we stay true in our tracking to the ''northstar'' of the NHAS; we assert that researchers' roles include that of evidence-based advocacy and we must recommit to these efforts. To do any less is to let down the people and communities most heavily and disproportionately impacted by HIV, and to dishonor the memory of so many loved ones who lost their lives to HIV.…”

Section: Discussionmentioning

confidence: 99%

Presidential Elections and HIV-Related National Policies and Programs

2017

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The November 2016 general election and subsequent voting of the Electoral College resulted in the selection of Donald Trump as President of the United States. The incoming Administration ran a campaign that indicated a desire for substantial change in health policy, including the repeal of the Affordable Care Act (ACA). President Trump has said very little directly about HIV programs and policies, but some campaign positions (such as the repeal of the ACA) would clearly and substantially impact the lives of persons living with HIV. In this editorial, we highlight important HIV-related goals to which we must recommit ourselves, and we underscore several key points about evidence-based advocacy that are important to revisit at any time (but most especially when there is a change in Administration).Resumen La elección nacional de Noviembre de 2016 y el voto subsecuente del Colegio Electoral resultaron en la selección de Donald Trump como Presidente de los Estados Unidos. La nueva Administración hizo campaña que indicaba el deseo para un cambio considerable en la polí-tica de la salud, incluyendo la revocación de la Ley del Cuidado de Salud Asequible (ACA). El Presidente Trump ha dicho muy poco directamente con respecto a sus políticas y programas para el VIH, pero algunas posiciones de la campaña (como la revocación de la ACA) tendrían un impacto claro y sustancial en las vidas de las personas que viven con el VIH. En este editorial, destacamos metas importantes relacionadas al VIH a las que debemos reafirmarnos, y subrayamos varios puntos claves sobre el apoyo basado en evidencia que son importantes a revisar en cualquier momento (pero especialmente cuando ha sucedido un cambio de Administración).

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“…14−17 Likewise, PrEP is paid for by state Medicaid programs. 14,15,18 Hence, the Medicaid expansions should increase HIV diagnoses, knowledge of HIV status, and PrEP use in a direct way. In addition, they may also increase HIV diagnoses, knowledge of HIV status, and PrEP use indirectly.…”

Section: Introductionmentioning

confidence: 99%

“…First, having health insurance may increase HIV diagnoses and PrEP use by increasing contact with healthcare providers, who are advised to screen and provide counseling for HIV to their patients. 15,16 Second, having health insurance may increase coverage of substance use treatment. Substance use treatment has been shown to facilitate HIV diagnoses 19,20 and may also increase awareness of PrEP and thus PrEP use.…”

Section: Introductionmentioning

confidence: 99%