In Four ACA Expansion States, The Percentage Of Uninsured Hospitalizations For People With HIV Declined, 2012–14

Hellinger, Fred J.

doi:10.1377/hlthaff.2015.0718

Cited by 13 publications

(6 citation statements)

References 20 publications

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“…There are lessons learned from A higher proportion of blacks (45%) versus whites (35%) living with HIV receive care via Medicaid nationally, 43 and states with expanded Medicaid have lower rates of being uninsured as well as fewer hospitalizations among people living with HIV. 43,44 Most of the 12 states that have not expanded Medicaid are in the southern United States, a region where 55% of the black community resides. The COVID-19 crisis and the accompanying economic downturn are prompting referenda in various red states to consider the adoption of Medicaid expansion, 45 which may increase health care access in communities of color and improve overall health outcomes.…”

Section: Focusing On Individual-level Risks Misses the Larger Narratimentioning

confidence: 99%

White Counties Stand Apart: The Primacy of Residential Segregation in COVID-19 and HIV Diagnoses

Millett

Honermann

Jones

et al. 2020

AIDS Patient Care and STDs

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Emerging epidemiological data suggest that white Americans have a lower risk of acquiring COVID-19. Although many studies have pointed to the role of systemic racism in COVID-19 racial/ethnic disparities, few studies have examined the contribution of racial segregation. Residential segregation is associated with differing health outcomes by race/ethnicity for various diseases, including HIV. This commentary documents differing HIV and COVID-19 outcomes and service delivery by race/ethnicity and the crucial role of racial segregation. Using publicly available Census data, we divide US counties into quintiles by percentage of non-Hispanic white residents and examine HIV diagnoses and COVID-19 per 100,000 population. HIV diagnoses decrease as the proportion of white residents increase across US counties. COVID-19 diagnoses follow a similar pattern: Counties with the highest proportion of white residents have the fewest cases of COVID-19 irrespective of geographic region or state political party inclination (i.e., red or blue states). Moreover, comparatively fewer COVID-19 diagnoses have occurred in primarily white counties throughout the duration of the US COVID-19 pandemic. Systemic drivers place racial minorities at greater risk for COVID-19 and HIV. Individual-level characteristics (e.g., underlying health conditions for COVID-19 or risk behavior for HIV) do not fully explain excess disease burden in racial minority communities. Corresponding interventions must use structural-and policy-level solutions to address racial and ethnic health disparities.

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Section: Focusing On Individual-level Risks Misses the Larger Narratimentioning

confidence: 99%

White Counties Stand Apart: The Primacy of Residential Segregation in COVID-19 and HIV Diagnoses

Millett

Honermann

Jones

et al. 2020

AIDS Patient Care and STDs

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“…3 A total of 11 ART-naive participants were excluded due to other/unknown insurance status. 4 Year since HIV diagnosis computed as of June 30, 2015. 5 Other/unknown HIV risk defined as the sum of Blood Transfusion, Coagulation Disorder, Other, Perinatal, and Unknown categories.…”

Section: Discussionmentioning

confidence: 99%

Despite Early Medicaid Expansion, Decreased Durable Virologic Suppression Among Publicly Insured People with HIV in Washington, DC

Goldstein¹,

Terzian

Monroe

et al. 2019

Preprint

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Background: Despite near-universal access to HIV care in Washington, DC, inequities in HIV outcomes persist. We hypothesized that laboratory monitoring and virologic outcomes would not differ significantly based on insurance type. Methods: We compared HIV monitoring with outcomes among people with HIV (PWH) with private (commercial payer) versus public (Medicare, Medicaid) insurance receiving care at community and hospital clinics. The DC Cohort follows over 8,000 PWH from 14 clinics. We included those ≥18 years old enrolled between 2011-2015 with stable insurance. Outcomes included frequency of CD4 count and HIV RNA monitoring (> 2 lab measures/year, >30 days apart) and durable viral suppression (VS; HIV RNA <50 copies/mL at last visit and receiving antiretroviral therapy (ART) for ≥12 months). Multivariable logistic regression models examined impact of demographic and clinical factors. Results: Among 3,908 PWH, 67.9% were publicly-insured and 58.9% attended community clinics. Compared with privately insured participants, a higher proportion of publicly insured participants had the following characteristics: female sex, Black race, heterosexual, unemployed, and attending community clinics. Despite less lab monitoring, privately-insured PWH had greater durable VS than publicly-insured PWH (ART-naïve: private 70.0% vs public 53.1%, p=0.03; ART-experienced: private 80.2% vs public 69.4%, p<0.0001). Privately-insured PWH had greater durable VS than publicly-insured PWH at hospital clinics (AOR=1.59, 95% CI: 1.20, 2.12; p=0.001). Conclusions: Paradoxical differences between HIV monitoring and durable VS exist among publicly and privately-insured PWH in Washington, DC. Programs serving PWH must improve efforts to address barriers creating inequity in HIV outcomes.

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“…Hellinger (2015) provides one of the earliest multi-state analyses on how Medicaid expansion affects uncompensated hospital care. Limiting to only four expansion states and two non-expansion states, he finds that Medicaid expansion reduces the percentage of uncompensated hospitalization for patients with HIV.…”

Section: Literature Reviewmentioning

confidence: 99%

Does the ACA Medicaid Expansion Affect Hospitals’ Financial Performance?

Zhang

Zhu

2021

Public Finance Review

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This paper examines the effects of states’ Medicaid expansion under the Affordable Care Act (ACA) on hospitals’ financial performance in the United States. Extending previous studies that primarily focus on the immediate short-term impact of the ACA's Medicaid expansion, we investigate if the fiscal effects persist over a longer-term and if the fiscal effects vary across different hospitals. Using panel data on hospitals from 2011 to 2018, we find that hospitals’ financial performance, as gauged either by Medicaid net revenue and uncompensated care cost or by multiple profitability measures, improves in Medicaid expansion states, and the positive effects continue over time. In addition, there are significant heterogeneities in the fiscal effects across different hospitals. Hospitals’ profitability improves the most in the public sector, rural areas, and less wealthy counties.

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In Four ACA Expansion States, The Percentage Of Uninsured Hospitalizations For People With HIV Declined, 2012–14

Cited by 13 publications

References 20 publications

White Counties Stand Apart: The Primacy of Residential Segregation in COVID-19 and HIV Diagnoses

White Counties Stand Apart: The Primacy of Residential Segregation in COVID-19 and HIV Diagnoses

Despite Early Medicaid Expansion, Decreased Durable Virologic Suppression Among Publicly Insured People with HIV in Washington, DC

Does the ACA Medicaid Expansion Affect Hospitals’ Financial Performance?

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