How Obamacare Will Affect HIV/AIDS Prevention

Noting successful HIV/AIDS prevention efforts rely on early diagnosis, an analysis published in the March 2014 issue of Health Affairs estimates that improved access to health insurance through the Affordable Care Act (ACA) will increase the number of patients getting tested for HIV by nearly 500,000 over a 5-year period, though that impact would be amplified if all US states opted to expand Medicaid coverage.

As part of an issue-wide series concerning the effects of the ACA’s implementation on HIV/AIDS patients, a team of researchers from the Leonard D. Schaeffer Center for Health Policy and Economics at the University of Southern California modeled the impact of health insurance expansion on testing, diagnoses, and HIV-unaware status between 2013 and 2017.

For their study, the investigators used 2 scenarios to offer upper and lower estimates of the ACA’s impact. The first anticipated only the 18 states and the District of Columbia that had committed to expanding Medicaid as of July 2013 actually did so, while the second assumed all 50 states and the District of Columbia participated in Medicaid expansion.

For both scenarios, the researchers used a macrosimulation model — which relied on data from reputable public- and private-sector sources, including the US Centers for Disease Control and Prevention (CDC) — to estimate the ACA’s impact on “the number of newly insured people who gained coverage as a result of the ACA; the number of the newly insured who were tested for HIV and who would not have been tested without coverage; and the number of the newly tested who were newly diagnosed as HIV-positive, and thus were newly aware of their HIV status.”

At the conclusion of their study, the authors predicted the ACA will “substantially increase the number of people being tested for HIV, with an additional 603,024 people being tested if all states expand Medicaid, (or) an additional 466,153 people if only the 18 committed states and the District of Columbia expand Medicaid,” which they noted is a 30% difference in impact. Although the study period was extended through 2017, the researchers’ model showed almost all of the increase in HIV testing will occur before 2016.

In terms of the effect of those presumed increases in testing, the authors found 2,598 additional new HIV diagnoses will be made by 2017 in the 18-state Medicaid expansion scenario, or 3,300 in the all-state scenario. In addition, HIV unawareness will be reduced by 22% between 2013 and 2017 among those unknowingly living with HIV/AIDS who become newly insured through the ACA.

“Making HIV-positive people aware of their status is at the forefront of HIV prevention. Yet, there are millions of people living with HIV/AIDS in the United States who are unaware of their HIV status,” the authors wrote. “A multi-prong approach is needed, (and) our analysis indicates that increasing health insurance might be an important part of such an approach.”

Since the ACA’s affect on HIV testing and diagnoses would be 30% greater if all states expanded eligibility for Medicaid coverage, the researchers advised that “policymakers should consider such epidemiological benefits when analyzing insurance expansion policies.”