Demographic, Insurance, and Health Characteristics of Newly Enrolled HIV-Positive Patients After Implementation of the Affordable Care Act in California.

Publisher: American Public Health Association Country of Publication: United States NLM ID: 1254074 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1541-0048 (Electronic) Linking ISSN: 00900036 NLM ISO Abbreviation: Am J Public Health Subsets: MEDLINE

Publication: Washington, DC : American Public Health Association
Original Publication: New York [etc.]

HIV Infections/*epidemiology ; Insurance, Health/*statistics & numerical data ; Patient Protection and Affordable Care Act/*statistics & numerical data; Adult ; Age Distribution ; California ; Cost Sharing ; Female ; Humans ; Male ; Middle Aged ; RNA, Viral/blood ; Sex Distribution ; Socioeconomic Factors ; United States

Objectives: To examine changes in HIV-positive patient enrollment in a large health care delivery system before and after key Affordable Care Act (ACA) provisions went into effect in 2014.
Methods: Analyses compared HIV-positive patients newly enrolled in Kaiser Permanente Northern California between January and June 2012 (n = 339) to those newly enrolled between January and June 2014 through the California insurance exchange or via other mechanisms (n = 549).
Results: After the ACA, the HIV-positive patient enrollment increased. These new enrollees were more likely to be male (93.6% vs 89.1%; P = .01), to be enrolled in high-deductible benefit plans (≥ $1000; 18.8% vs 5.5%; P = .01), and to have better HIV viral control (HIV RNA levels below limits of quantification 79.5% vs 73.6%; P = .05) compared with pre-ACA new enrollees. Among post-ACA new enrollees, there were more patients in the lowest and highest age groups. Post-ACA exchange enrollees (22%) were more likely to be male and to have high-deductible plans than those enrolled through other mechanisms.
Conclusions: More men, higher deductibles, and better HIV viral control characterize newly enrolled HIV-positive patients after the ACA in California.
Public Health Implications: Evolving characteristics of HIV-positive enrollees may affect HIV policy, patient care needs, and service utilization.

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R21 DA035645 United States DA NIDA NIH HHS; R33 DA035645 United States DA NIDA NIH HHS

0 (RNA, Viral)

Date Created: 20160415 Date Completed: 20170608 Latest Revision: 20181113

20221213

PMC4902724

10.2105/AJPH.2016.303126

27077361