HIV Safety Net Still Needed Despite Affordable Care Act Coverage

Ryan White HIV/AIDS Program offers medical care and services for low income, uninsured, and underinsured individuals.

Despite coverage options under the Affordable Care Act (ACA), a recent study concluded that the Ryan White HIV/AIDS Program remains a necessity for HIV patients.

The program, launched after the Indiana teenager contracted AIDS during a blood transfusion in the 1980s, offers medical care and services for low income, uninsured, and underinsured individuals.

It was theorized that the launch of the ACA in 2014 would eventually phase out the medical safety net the Ryan White program provides. However, in a study published in Clinical Infectious Diseases, researchers discovered that this was not the case.

“Our study shows that Congress and the White House should continue strong support for the Ryan White HIV/AIDS Program despite the ACA,” said lead study author Stephen Berry, an HIV specialist. “The program's support remains the only mechanism for tens of thousands to receive basic HIV care to prevent HIV transmission and death from AIDS.”

For the study, researchers collected information from the HIV Research Network focusing on people who relied completely on the Ryan White HIV/AIDS Program for insurance coverage.

Insurance coverage for HIV provider visits for 28,374 patients from 10 clinics between 2011 and 2013 were compared against pre-ACA figures and the first 6 months of 2014 after the act was in effect.

The results of the study found there was little change in participation in the Ryan White program pre- and post-ACA in non-expansion states Texas and Florida. There was 52% of all patients who still relied on the program for coverage in 2014. There was a drop in reliance from 28% to 13% overall seen in California, Maryland, and Oregon (states that expanded Medicaid).

However, the change fell below expectations.

“A lot of people hypothesized that reliance on Ryan White would go down to maybe 5% following the implementation of the ACA,” Berry said.

However, the findings showed that cutbacks in the program would result in stopping care for many patients, largely due to some states not expanding Medicaid.

“Every single year, the Ryan White HIV/AIDS Program has the potential to be cut back when Congress is looking at ways to save money,” Berry said. “But cutting the program back would be a mistake.”

In an accompanying commentary to the study, authors Ellen Eaton and Michael Mugavero pointed out that the study only included data from the first half of 2014, excluding patients still struggling to sign up for the ACA. However, Berry noted that newer data showed the pattern in all study sites remained unchanged by the end of 2014 compared with the first half.

Although some people eventually leave the Ryan White HIV/AIDS Program for provider visit coverage, the program still remains crucial for primary and secondary medication coverage, as well as for clinic wraparound services, according to the study. Without these programs, Berry stated that people are more likely to skip their medications.

There are approximately 500,000 people in the United States who receive at least one form of support from the Ryan White program, while about 100,000 have no health coverage and rely solely on the program for outpatient care and medications.