XIX International AIDS Conference

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MOPE606 - Poster Exhibition


State healthcare access modeling project: preparing for a changing healthcare landscape in the United States

R. Greenwald

Harvard Law School, Center for Health Law and Policy Innovation, Jamaica Plain, United States

Background: The Affordable Care Act (the ACA) will expand healthcare coverage for millions of Americans, in part by expanding Medicaid access and offering subsidies for the purchase of private health insurance. While the U.S. pays the largest proportion of GDP toward healthcare, the WHO ranks its healthcare system 37th in the world. The ACA offers promise to people living with HIV and AIDS (PLWHA) in the U.S., outlawing discrimination by insurance companies on the basis of health status, funding prevention initiatives, and investing in community health. Currently, thousands of PLWHA obtain healthcare from the Ryan White Program and the AIDS Drug Assistance Program (ADAP). This Project analyzes data from fourteen states regarding access to care by PLWHA and how the healthcare landscape will change for PLWHA when the ACA is fully implemented.
Methods: The study population for this project constitutes PLWHA in the U.S. with incomes below 400% of the Federal Poverty Level. Data on demographics, current access to healthcare services, and the ways in which access is expected to improve were compiled and analyzed using qualitative and statistical methods.

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Results:

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Conclusions: A significant proportion of PLWHA currently excluded from traditional American sources of healthcare coverage will have access to comprehensive coverage through Medicaid or private insurance upon ACA implementation. Yet challenges remain, including the failure to fully address ongoing health disparities between states (and between subpopulations within states), the lack of comprehensive planning to meet gaps in treatment and service needs, and the unaddressed needs of those PLWHA who will not be eligible for Medicaid or private insurance subsidies (largely recent migrants to the United States) The ACA presents important opportunities and challenges for bringing healthcare systems closer to HIV treatment guidelines and for developing successful advocacy strategies for accessing comprehensive care for PLWHA.

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