Researchers reveal effects of Affordable Care Act on low-income Virginians with HIV

In an important examination of the effect of the Affordable Care Act, researchers have determined that low-income Virginians with HIV had better outcomes when enrolled in Affordable Care Act healthcare plans. The study is believed to be the first to compare Affordable Care Act outcomes with the previous standard of care for this vulnerable patient population.

The researchers looked at the rates of virologic suppression, the most critical outcome in HIV care, among those enrolled in Affordable Care Act plans and those who received care under the state's AIDS Drug Assistance Program (ADAP). When patients achieve virologic suppression, they have little or no virus detectable in their blood, which benefits the patient and helps public health by preventing transmission of the disease. More than 85 percent (85.5 percent) of patients with Affordable Care Act (ACA) insurance were found to be in a state of virologic suppression, compared with 78.7 percent of those in ADAP.

"Virginia was a great place to study this healthcare delivery transition since it was a regional and national leader in the ADAP transition from direct medication provision to purchasing of ACA insurance. This is a one-state study, but it's applicable to the 19 other states that also haven't expanded Medicaid, as well as to Medicaid-ineligible patients in states where Medicaid has expanded," said researcher Kathleen McManus, MD, of the University of Virginia School of Medicine's Division of Infectious Diseases and International Health.

ACA Enrollment

The two-year study looked at 3,933 patients eligible for ACA insurance who were Virginia ADAP clients. Of those, 1,849 (47.1 percent) enrolled, while 2,084 (52.9 percent) continued to receive care through the previous standard of care, ADAP.

The researchers found:

• Patients ages 25 to 34 and 35 to 44 were less likely to enroll than those younger or older;
• blacks were less likely to enroll than whites;
• people with AIDS were less likely to enroll than those with HIV;
• women were more likely to enroll;
• patient groups specifically targeted for enrollment, such as people whose insurance was ending, were more likely to enroll.

The researchers also found that the earlier a patient enrolled in ACA insurance, the better they tended to fare. "It was a dose-dependent relationship, so if you enrolled in ACA insurance in January, you were more likely to be virologically suppressed than if you enrolled in June," McManus said.

McManus' mentor and fellow researcher, Rebecca Dillingham, MD/MPH, noted that the findings represent an additional piece of evidence that having sustained health insurance improves health outcomes. "We saw that those who fall into insurance gaps, many of whom would qualify for Medicaid if it were expanded, are less likely to have good clinical outcomes. Missing opportunities to cover these individuals contributes to persistent health disparities."

Findings Presented

McManus presented the findings at IDWeek 2015, a conference held in San Diego. The research team also included Anne Rhodes, Lauren Yerkes and Steven Bailey of the Virginia Department of Health and UVA's Carolyn L. Engelhard, Karen S. Ingersoll and George J. Stukenborg.