Health Insurance Coverage for People with HIV Under the Affordable Care Act: Experiences in Five States
The Kaiser Family Foundation and PerryUndem conducted ten focus groups in five states – California, Florida, Georgia, New York, and Texas. Within these states, focus groups were conducted in the cities of Los Angeles, Miami, Atlanta, New York City, and Dallas. The states were chosen for geographic diversity, burden of the epidemic, and varying state approaches to health reform implementation, including Medicaid expansion decisions. Two of the states – California and New York – have moved ahead with Medicaid expansion while the remaining three – Florida, Georgia, and Texas – have not; in addition, California and New York have chosen to run their own marketplaces while Florida, Georgia and Texas have defaulted to the federally-facilitated marketplace. Five of the focus groups were conducted among participants who (successfully or unsuccessfully) attempted to enroll in a Qualified Health Plan (QHP) through the ACA. Two groups were conducted among participants newly enrolled in Medicaid coverage through the ACA. Three were conducted among uninsured participants in non-expansion states (See Table 1).
All focus group participants were age 18 and older. A total of ninety individuals participated in the focus groups, which were racially and ethnically diverse and represented a range of sexual orientations and gender identities. The groups were predominantly male but female participants were also represented. All groups took place between June and September of 2014 after the close of the first open enrollment period (which was intended to end on March 31, 2014 but was extended to mid-April in most marketplaces). As such, they represent the experiences of participants during that period only. Given that the groups were conducted fairly early into participants experience with coverage, some had not fully used their new insurance and the findings presented here are limited to that extent. All participants were recruited using professional focus group facilities and community based organizations (CBOs), and groups took place within both settings. Participants and CBOs were compensated for their participation.
It is important to note that while focus groups are helpful for exploring experiences and themes around a given subject and enhancing our understanding of a particular phenomenon, they are not intended to offer definitive explanations or answers and are not necessarily representative of the entire population being studied.