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

Published in: American Journal of Public Health, v. 106, no. 7, July 2016, p. 1211-1213

Posted on RAND.org on September 13, 2016

by Derek D. Satre, Sujaya Parthasarathy, Andrea Altschuler, Michael Silverberg, Erik D. Storholm, Cynthia I. Campbell

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Research Question

  1. What were the characteristics of HIV-positive patients newly enrolled in a large California health plan after key provisions of the ACA took effect in 2014?

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.

Key Findings

  • HIV-positive patient enrollment increased after the ACA.
  • New enrollees were more likely to be male, to be enrolled in high-deductible benefit plans, and to have better HIV viral control.

Recommendation

HIV policy, patient care needs, and service utilization may need adjustment to account for evolving characteristics of HIV-positive enrollees.

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