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More Than 25% of HIV Providers Don't Know If Their State Expanded Medicaid

Jaime Rosenberg
A survey has revealed gaps in HIV providers’ knowledge of the Affordable Care Act. However, despite these gaps, the majority of surveyed providers expressed belief that Medicaid expansion would improve both HIV outcomes and general outcomes for patients with the disease.
People living with HIV account for a significant portion of the uninsured, and the Affordable Care Act (ACA) provided increased access to insurance coverage for this patient population. However, a survey has put a spotlight on gaps in HIV providers’ knowledge of the ACA, with more than a quarter of providers not knowing if their state has expanded Medicaid.

Despite these knowledge gaps, a majority of surveyed providers expressed that Medicaid expansion would improve both HIV outcomes and general outcomes for patients with the disease.

The survey included more than 250 HIV care providers and asked 4 questions regarding knowledge of the ACA between December 2014 and September 2015:
  1. Does the ACA provide subsidies for people with low incomes to purchase health insurance?
  2. Does the ACA make it illegal to exclude a person from an insurance plan due to a preexisting condition?
  3. Does the ACA eliminate the Ryan White HIV/AIDS Program?
  4. Did your state decide to move forward with the ACA optional Medicaid expansion?

The majority (61%) of providers answered all 4 questions right, and approximately one-third answered “I don’t know” to at least 1 question. Providers in Medicaid expansion states were more likely to get all 4 questions right (71% vs 57%).

Eighty-six percent knew that the ACA provides subsidies for health insurance to those with low incomes, and 90% knew it made it illegal to exclude people with preexisting conditions from an insurance plan. The overwhelming majority (91%) also knew that the ACA did not eliminate the Ryan White Program.

However, less (73%) knew whether or not their state expanded Medicaid.

“Interestingly, 32% of HIV medical providers reported learning ACA information from their clinic patients,” noted the researchers. “Websites and newspapers or magazines were the 2 most commonly reported sources, and they were most often cited as a medical provider’s main source of ACA information."

Attitudes toward the ACA were measured on a scale of 1 to 5, ranging from strongly disagree to strongly agree. The mean response for “The ACA will improve the US’ health outcomes” was 3.95, and the mean response or “The ACA will improve my HIV patients’ non-HIV outcomes” was 3.93. Answers were similar across providers in Medicaid expansion states and nonexpansion states.

However, the mean response for “The ACA will improve my HIV patients’ HIV outcomes” was 3.61, and answers varied between providers in expansion and nonexpansion states. Providers in expansion states agreed more strongly that the ACA would have this benefit.

“This is notable given that the average published pre-ACA viral suppression rate for people living with HIV on Medicaid has been reported to be 65% to 68%,” wrote the researchers. “…From pre-ACA to the first year of the ACA, viral suppression increased from 74% to 78% for people living with HIV with Medicaid in Medicaid nonexpansion states and increased from 75% to 80% for people living with HIV in Medicaid expansion states.”

Reference

McManus K, McManus K, Dillingham R. National survey of United States human immunodeficiency virus medical providers' knowledge and attitudes about the Affordable Care Act [published August 25, 2018]. Clin Infect Dis. doi: https://doi.org/10.1093/cid/ciy296.

 
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