People living with HIV are more comfortable with navigating health insurance two years into the Affordable Care Act's major coverage expansions, according to a new Kaiser Family Foundation report.
Those who have purchased insurance through the ACA marketplaces and who are covered by Medicaid recognize their new benefits but often continue to worry about maintaining coverage. Those with private insurance also remain concerned about the affordability of their coverage. Many people living with HIV in states without Medicaid expansion remain uninsured, the report found.
The report, based on focus groups conducted in five states, takes another look at the impact of the ACA on people with HIV in California, Florida, Georgia, New York and Texas. Observations are drawn from interviews in early 2016 in which participants discussed their experiences with the ACA, following up on an earlier report from 2014 when coverage opportunities were only newly available.
Here are six findings from the report.
1. In 2014, participants who gained insurance coverage were still in the early stages of figuring out how to use it, but insured participants in 2016 used their coverage regularly to meet their HIV care and treatment needs, according to the report. They said their health is easier to manage as a result of gaining coverage and appear better able to navigate using insurance than their 2014 counterparts.
2. Still, even with some increased comfort with coverage, participants remain unsure of how to fully assess plan options and, as in 2014, put a lot of trust in case managers to help make enrollment decisions, the report found. They still lack some basic insurance literacy, but many participants across the sites knew that access to healthcare varied across the nation.
3. The insured recognized the benefits of gaining coverage, although some worry about being able to maintain coverage, according to the report. Those with private insurance worry about costs and those with Medicaid find recertification stressful.
4. Only a few participants have made changes to their plans since first enrolling. One individual switched to a different metal level plan by choice and was unexpectedly met with higher costs and two others were automatically moved into new coverage.
5. As with the 2014 groups, those who live in states that have not expanded Medicaid and remain uninsured, largely because they fall into the coverage gap, feel they can meet their HIV care and treatment needs through HHS' Ryan White HIV/AIDS Program, but have many other health problems that are going unaddressed.
6. Most respondents in 2016 said their finances are the biggest stress in their lives; they struggle to make ends meet and many face substantial medical debt, according to the report.
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