The ACA and People with HIV: An Update
The Kaiser Family Foundation and PerryUndem Research/Communications conducted one focus group in each of five states – California, Florida, Georgia, New York, and Texas in February of 2016 just after the close of the third open enrollment period. Within these states, focus groups were conducted in the cities of Los Angeles, Miami, Atlanta, New York City, and Dallas. These sited were selected for geographic diversity, burden of the epidemic (these states alone account for about half of the nation’ epidemic)1, and their different 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 three – Florida, Georgia, and Texas – have not. Additionally, California and New York run their own Marketplaces while Florida, Georgia and Texas rely on the federally-facilitated Marketplace. Focus groups conducted in California and New York included participants who gained insurance through an ACA era coverage opportunity, via either the Marketplace or through Medicaid expansion. The groups conducted in Florida, Georgia and Texas included participants who remained uninsured, largely because they fell into the coverage gap, though two individuals who are undocumented also participated. The uninsured respondents all had incomes below 139% of the federal poverty level which means that had these states expanded Medicaid, and the respondent was otherwise eligible, they may have been able to find coverage. (See Table 1 in report.)
All focus group participants were older than age 18 and younger than 65. Groups were racially and ethnically diverse and represented a range of sexual orientations. The groups were predominantly male but female participants were also represented. Each focus group consisted of between 4-10 HIV positive individuals. Given the very narrow parameters for the focus groups, respondents were over recruited and individuals who did not appear to meet the eligibility criteria were excluded from participating. The narrow parameters prevented “full” recruitment at each focus group site with identifying Marketplace enrollees being especially challenging. This is a limitation to the research. Individuals gained coverage at different times over the past few years and thus had coverage experiences for varying amounts of time. 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 focus groups are intended to help explore experiences and themes around a given subject, but do not offer definitive explanations or answers and are not necessarily representative of the entire population being studied.
This issue brief was prepared by Lindsey Dawson and Jennifer Kates of the Kaiser Family Foundation and Michael Perry and Kathleen Perry of PerryUndem Research and Communication.
The authors of this study would like to express their sincere gratitude to the focus group participants for sharing their time and their stories and to the staff at the CBOs who helped with recruitment and group logistics.