In an important examination of the effect of the Affordable Care Act, researchers have determined that low-income Virginians with the human immunodeficiency virus had better outcomes when enrolled in Affordable Care Act health care plans. The study is believed to be the first to compare Affordable Care Act outcomes with the previous standard of care for this vulnerable patient population.

Dr. Kathleen McManus’ study found that low-income HIV patients with Affordable Care Act insurance fared better than those who remained in the former program.

The researchers looked at the rates of virologic suppression, the most critical outcome in HIV care, among those enrolled in Affordable Care Act plans and those who received care under the state’s AIDS Drug Assistance Program, or ADAP. When patients achieve virologic suppression, they have little or no virus detectable in their blood, which benefits the patient and helps public health by preventing transmission of the disease. The study found that 85.5 percent of patients with Affordable Care Act insurance were found to be in a state of virologic suppression, compared with 78.7 percent of those in the state’s AIDS program.

“Virginia was a great place to study this health care delivery transition, since it was a regional and national leader in the ADAP transition from direct medication provision to purchasing of [Affordable Care Act] insurance,” said researcher Dr. Kathleen McManus of the University of Virginia School of Medicine’s Division of Infectious Diseases and International Health. “This is a one-state study, but it’s applicable to the 19 other states that also haven’t expanded Medicaid, as well as to Medicaid-ineligible patients in states where Medicaid has expanded.”

The two-year study looked at 3,933 patients eligible for Affordable Care Act insurance who were Virginia ADAP clients. Of those, 1,849 (47.1 percent) enrolled, while 2,084 (52.9 percent) continued to receive care through the previous standard of care, ADAP.

The researchers found:

• Patients ages 25 to 34 and 35 to 44 were less likely to enroll in Affordable Care Act health plans than those younger or older;
• blacks were less likely to enroll than whites;
• people with AIDS were less likely to enroll than those with HIV;
• women were more likely to enroll;
• patient groups specifically targeted for enrollment, such as people whose insurance was ending, were more likely to enroll.
• The researchers also found that the earlier a patient enrolled in Affordable Care Act insurance, the better they tended to fare. “It was a dose-dependent relationship, so if you enrolled in ACA insurance in January, you were more likely to be virologically suppressed than if you enrolled in June,” McManus said.

McManus’ mentor and fellow researcher, Dr. Rebecca Dillingham, noted that the findings represent an additional piece of evidence that having sustained health insurance improves health outcomes.

“We saw that those who fall into insurance gaps, many of whom would qualify for Medicaid if it were expanded, are less likely to have good clinical outcomes,” Dillingham said. “Missing opportunities to cover these individuals contributes to persistent health disparities.”

McManus presented the findings at IDWeek 2015, a conference held in San Diego. The research team also included Anne Rhodes, Lauren Yerkes and Steven Bailey of the Virginia Department of Health and UVA’s Carolyn L. Engelhard, Karen S. Ingersoll and George J. Stukenborg.

This project was supported by a grant from the Agency for Healthcare Research and Quality. The content of this news release is solely the responsibility of the study authors and does not necessarily represent the official views of the AHRQ.