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An Update on Insurance Coverage Among People with HIV in the United States

Key Facts

  • Health insurance and access to care improve health outcomes, including viral suppression, for people with HIV in the United States. Our prior research documented an increase in insurance coverage between 2012 and 2014 among people with HIV, after implementation of the Affordable Care Act (ACA).1 In this update, based on analysis of nationally representative data, we find that by 2015, just 1 in 10 (11%) nonelderly people with HIV were uninsured, on par with the rate in the general population (13%), which had fallen to historic lows due to the ACA.
  • At the same time, there are important differences in coverage for people with HIV, compared to the general population. Medicaid represents the single largest source of coverage for people with HIV, much more so than for the general population (40% compared to 15%) and people with HIV are much less likely to be covered by private insurance that the population overall (34% compared to 68%).
  • A main factor driving increased coverage for people with HIV has been the ACA’s Medicaid expansion.2 Among expansion states sampled, the share of people with HIV who are uninsured is significantly lower (5% v. 19%) and rates of Medicaid coverage significantly higher (48% v 29%), compared to non-expansion states.

    Nearly half (46%) of people with HIV rely on the #RyanWhite program for outpatient care and support services. This includes most (82%) of the uninsured as well as many (41%) with health insurance.

  • The Ryan White HIV/AIDS Program plays a major role in providing outpatient care and support services to people with HIV, regardless of insurance coverage. Almost half of all people with HIV (46%) rely on Ryan White, as do more than eight in ten (82%) of those who are uninsured. Among those with insurance coverage, 41% rely on Ryan White, including a greater share of those with marketplace coverage (60%).
  • We looked at rates of viral suppression by insurance coverage as well as reliance on Ryan White. While overall viral suppression rates did not vary by coverage type, sustained viral suppression (that is, having an undetectable viral load over the preceding 12 months) was significantly higher among those with private insurance and Medicare, compared to the uninsured. In addition, those who relied on Ryan White were significantly more likely to have sustained viral suppression, driven in particular by those with both Ryan White and Medicaid.

Introduction

Health insurance improves access to care and, ultimately, health outcomes, including viral suppression, for people with HIV in the United States.3 Based on analysis of data from the Centers for Disease Control (CDC) and Prevention’s Medical Monitoring Project (MMP), our prior research documented an increase in insurance coverage between 2012 and 2014 among nonelderly people with HIV in care, after implementation of the Affordable Care Act’s (ACA) major coverage reforms.4 This data note provides updated MMP data for 2015, drawing on the MMP’s expanded sample compared to previous years.5 It also examines the role of the Ryan White HIV/AIDS Program and looks at rates of viral suppression by coverage. Such findings can help to inform the Administration’s Ending the HIV Epidemic Initiative, a new effort to reduce HIV infections by 90% by 2030 which depends, in part, on engaging people with HIV in care and treatment and achieving viral suppression.6

FIndings