March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (ACA) that extensively changes the way in which health care is financed and provided in the United States (P.L. 111-148). This section of the report provides an overview of federal and state programs and policies that affect access to HIV/AIDS care and how these programs may be affected by the recent health care reform.
Health Insurance Policies
Having health coverage is critical to gaining access to HIV/AIDSrelated care due to the high expense involved in medical management of the disease. Care for people with HIV may be covered through federal programs such as Medicaid, Medicare, the Ryan White program, and the Department of Veterans Affairs (VA); community health centers (CHCs); private health insurance; or a combination of programs.
There are no recent national estimates of health coverage of individuals with HIV. The HIV Cost and Service Utilization Study (HCSUS), for example, the only nationally representative study of people with HIV/AIDS in care, was conducted from 1994 to 2000.2 A recent analysis of data from a convenience sample involving 12 medical sites located in urban cities throughout the United States showed that the majority of patients were covered under Medicaid (42 percent, including those dually eligible for Medicare) and the Ryan White program (24 percent) (Table 2).3 These data likely do not represent the national picture of health coverage of individuals with HIV, however, such as those in non-urban areas.
2 HCSUS estimated that of the estimated 231,400 HIV-infected adults living in the contiguous United States at the time, 32 percent had private health insurance, 29 percent had Medicaid alone, and 20 percent had no insurance. Nineteen percent of patients had Medicare with or without other health insurance (Bozzette et al., 1998)
3 Data are from medical sites located in Baltimore, Maryland; Tampa, Florida; Dallas, Texas; New York City, New York (3 sites); Rochester, New York; Philadelphia, Pennsylvania; Detroit, Michigan; San Diego, California; Oakland, California; and Portland, Oregon.