Monitoring HIV Care in the United States A Strategy for Generating National Estimates of HIV Care and Coverage (2012) / Chapter Skim
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2 Implications of Health Care Reform for People with HIV in the United States
2 Implications of Health Care Reform for People with HIV in the United States
Pages 53-72
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From page 53... ...
; and individual state health plans. [Types of insurance are not mutually exclusive; people may be covered by more than one during the year.]
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From page 54... ...
, gradual elimination of the Medicare Part D prescription drug coverage gap, and development of an "essential health benefits package" and improved coverage for preventive care services.4 2Individuals were identified as underinsured if they had health insurance for the full year but also had very high medical expenses relative to their income (Schoen et al., 2011)
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. One of the concerns raised by the variation in state adoption of Medicaid expansion is the potential lack of health coverage options for individuals who remain ineligible for Medicaid in states that opt out of Medicaid expansion but who have incomes below the level of eligibility for federal subsidies to purchase insurance coverage through the state exchanges (KFF, 2012a)
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Individuals without access to employer-based coverage who are not eligible for Medicaid or Medicare but are eligible for tax credits to purchase insurance and/or can afford to pay for health insurance may do so through state health insurance exchanges established to facilitate the purchasing of health insurance by qualified individuals and employers. As it did prior to the enactment of the ACA, the Ryan White HIV/AIDS Program continues to serve as a payer of last resort for people with HIV who are under- or uninsured.
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For current state eligibility requirements, see Kaiser Family Foundation (KFF) , State Health Facts, Medicaid Income Eligibility Limits for Adults as a Percent of Federal Poverty Level, http://statehealthfacts.org/ comparereport.jsp?
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ind=602&cat=7. dRyan White: The Ryan White HIV/AIDS Program, the single largest federal program designed specifically for people with HIV in the United States, provides care and services for people with HIV who are uninsured or underinsured, serving as payer of last resort.
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. For current state eligibility requirements and information on which states have moved to expand Medicaid as permitted by the ACA, see, Kaiser Family Foundation, State Health Facts, Medicaid Income Eligibility Limits for Adults as a Percent of Federal Poverty Level, http://statehealthfacts.org/comparereport.jsp?
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For current state eligibility requirements and information on which states have moved to expand Medicaid as permitted by the ACA, see KFF, State Health Facts, Medicaid Income Eligibility
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See KFF, State Health Facts, State Action Toward Creating Health Insurance Exchanges, http://www.statehealthfacts.org/comparemaptable.
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. Medicaid Expansion Medicaid currently is the largest single source of health care coverage for people living with HIV, providing coverage for 47 percent of HIVinfected individuals estimated to be receiving regular medical care (Kates, 2011, p.
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From page 63... ...
. Essential Health Benefits Package and Preventive Care The ACA charges HHS with establishing an "essential health benefits package" within specified parameters whose scope "is equal to the scope of benefits provided under a typical employer plan, as determined by the [HHS]
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From page 64... ...
. STATE IMPLEMENTATION Although the ACA establishes federal mandates and standards regarding health insurance, states are among those entities responsible for implementing some of the most significant changes, such as establishment of state health insurance exchanges and whether to accept the Medicaid expansion provision.12 Box 2-1 lists some of areas in which state variation in implementation of the ACA is anticipated.
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From page 65... ...
Some states are in a better starting position than others to implement the ACA. Massachusetts, for example, enacted health reform legislation in 2006 that is similar to the ACA, including an individual mandate, Medicaid expansions, subsidized private insurance coverage, and a purchasing pool (Long and Masi, 2009)
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.13 OPPORTUNITIES, CHALLENGES, AND LIMITATIONS The ACA offers great opportunities for significant expansion of access to health care, improved health outcomes, and emphasis on preventive care for millions of Americans including most of the almost 30 percent of people living with HIV who currently lack any form of health care coverage (CMS, 2010; HHS, 2012a)
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Federal Exchange (16) Undecided (11)
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Another challenge raised by health care reform is that increased access to health care coverage under the ACA will facilitate but not ensure linkage to, retention in, and provision of quality clinical HIV care for people living with HIV. Although the number of uninsured HIV-infected individuals will decrease, people near the eligibility borders may be expected to "churn" (i.e., move back and forth)
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From page 69... ...
. The possibility of "churning" between coverage sources, the movement of individuals from the Ryan White HIV/AIDS Program into other subsidized programs, and concerns about the availability of competent health care services sufficient to meet the needs of people living with HIV underscore the importance not only of tracking changes in health care coverage for people with HIV but also of monitoring service utilization and care quality using indicators such as those recommended in the committee's first report (IOM, 2012)
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2012a. How Does the Affordable Care Act Impact People Living with HIV/AIDS.
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2012f. State Health Facts: Income Eligibility Limits for Working Adults at Application as a Percent of the Federal Poverty Level (FPL)
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