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A cross-jurisdictional evaluation of insurance coverage among HIV care patients following the Affordable Care Act

机译：经济实惠的护理法案后艾滋病毒护理患者保险覆盖的交叉司法评价

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The impact of the Affordable Care Act (ACA) on HIV care patients, aged 18-64, was evaluated in three jurisdictions with Medicaid expansion (Chicago, New York State, and Washington) and three jurisdictions without Medicaid expansion (Georgia, Texas, and Virginia) using data from the Medical Monitoring Project. Multivariate regression models were used to evaluate insurance status that was reported pre-and post-ACA; self-reported impact of ACA on HIV care was explored with descriptive statistics. The likelihood of having insurance was significantly greater post-ACA compared to pre-ACA in Chicago (aRR = 1.33, 95% CI = 1.20, 1.47), Washington (aRR = 1.15, 95% CI = 1.08, 1.22), and Virginia (aRR = 1.14, 95% CI = 1.00, 1.29). In Washington and Chicago, the likelihood of being Medicaid-insured was greater post-ACA compared to pre-ACA implementation (Chicago: aRR = 1.25, 95% CI = 1.03,1.53; Washington: aRR = 1.66 95% CI = 1.30, 2.13). No other significant differences were observed. Only a subset of HIV care patients (range: 15-35%) reported a change in insurance that would have coincided with the implementation of ACA; and within this subset, a change in medical care costs was the most commonly noted issue. In conclusion, the influence of ACA on insurance coverage and other factors affecting HIV care likely varies by jurisdiction.
机译：合理的护理法令（ACA）对18-64岁的艾滋病毒护理患者的影响是在与医疗补助扩张（芝加哥，纽约州和华盛顿）的三个司法管辖区的三个司法管辖区，以及没有医疗补助的扩张（格鲁吉亚，德克萨斯州和弗吉尼亚州）使用医学监测项目的数据。多元回归模型用于评估报告的保险状况，据报道预先和aca后;通过描述性统计，探讨了ACA对艾滋病毒护理的自我报告的影响。与芝加哥预痤疮（ARR = 1.33,95％CI = 1.20,15.17），华盛顿（ARR = 1.15,95％CI = 1.08,1.22）和弗吉尼亚（1.22）和弗吉尼亚（1.22）和弗吉尼亚（1.22）和弗吉尼亚（1.22）和弗吉尼亚（1.22）和弗吉尼亚州（ARR = 1.15,95％CI = 1.08，1.22）和弗吉尼亚（ arr = 1.14,95％ci = 1.00,1.29）。在华盛顿和芝加哥，与ACA预实施相比，医疗保险保险的可能性更大（芝加哥：ARR = 1.25,95％CI = 1.03,1.53;华盛顿：ARR = 1.66 95％CI = 1.30，2.13 ）。没有观察到其他显着差异。只有艾滋病毒护理患者的副本（范围：15-35％）报告了恰逢ACA的实施情况的变化;在这个子集中，医疗费用的变化是最常见的问题。总之，ACA对影响艾滋病毒护理的其他因素的影响可能因司法管辖区而异。

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