two assumptions in estimating the benefits and costs of the program. The first assumption is that the implementation of the HIV-CCP would not have the effect of providing incentives for the privately insured to discontinue their coverage and enroll in the program, resulting in “crowd-out” and an increase in the publicly insured population. This assumption is based on recent findings indicating that subsidized health insurance for low-income persons did not result in crowd-out in four state programs among adults with incomes below 100 percent of poverty. Some crowd-out did occur among person with incomes of 100 to 200 percent of poverty in two states (Kronick and Gilmer, 2002). Though it is reasonable to expect there will be some level of crowd-out if the program is implemented, any estimation of its potential effects was deemed too unreliable to be included in the Committee’s calculations. Thus, an estimated 167,500 individuals who are aware of their infection and privately insured are not included in the policy changes being modeled. The second assumption is that the creation of a health care entitlement will not increase enrollment in care or increase HAART use among individuals who are unaware of their HIV status.2 Thus, the estimated 280,000 individuals who are unaware of their HIV serostatus are also not included in the modeling.

Anticipated HAART Use Gain and Program Enrollment of HIV-CCP

As discussed previously, 670,000 individuals are aware of their positive HIV serostatus; of these, the Committee estimates that 69 percent (463,070) are in need of HAART as determined by treatment guidelines (Table 6-1). Evidence from Kahn and colleagues (2002) indicates that slightly less than half of those who need HAART (230,000 individuals) receive it, leaving 233,070 individuals with an unmet need for HAART. Among those on HAART, the Committee estimates that 73 percent (167,650) are publicly insured through Medicaid, Medicare, or both, or are uninsured and rely on a public program to finance their care. Of those who need HAART but do not receive it, the Committee estimates that 77 percent (180,314) are publicly insured or uninsured.

Program Eligibility and HAART Gain for the HIV-CCP

Using the federal poverty level of $8,860 for an individual in 2002, and extrapolating from the HIV Cost and Services Utilization Study (HCSUS)


This assumption underlies the Committee’s base case analysis and results. A univariate sensitivity analysis was performed, however, for 36 model input values, including total population estimates. The sensitivity analysis produced results for values of ±20% of the base case. These results are presented in Appendix A.

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