Study: Obama Care Offers Better HIV Viral Suppression Than ADAP Coverage

Tally another win for President Obma's lofty public health policy. Not only does a new University of Virginia study demonstrate that Obamacare is better for people with HIV in suprressing viral loads, it also saved the state enough money to get other poz people off their AIDS Drug Assistance Program waitlist.

Presented last week at ID Week, the annual meeting of professionals who deal with infectious diseases, the research showed that patients enrolled in Affordable Care Act health care plans had higher rates of viral suppression (little or no HIV virus detected in the blood), than people who were only able to access HIV medications through Virginia’s direct AIDS Drug Assistance Program (ADAP).

“We found patients fared better under ACA health plans, possibly due to broader access to medical care and medications beyond those that target HIV,” said Kathleen McManus, lead author of the study and a physician in the Division of Infectious Diseases and International Health at the University of Virginia School of Medicine in Charlottesville. “Additionally, this approach allows the state to cover the largest number of patients in the most cost-effective way. ACA plans provide more comprehensive care for the same or less money.”

The study has particular relevance for those fighting HIV in the South because, like most of the Southern states, Virginia elected not to expand Medicaid. Because Virginia rejected expanding the federally-funded program, many of the state’s poor remain ineligible for Medicaid and aren’t receiving quality health care because they still can’t afford insurance and/or medications.

Virginia does provide care for low-income residents living with HIV through the ADAP program. Since the passage of the ACA, ADAP has two options for supporting medical care. Through the first, the state pays for medications, and HIV-positive clients receive treatment through Ryan White-funded clinics. The second option is for people to sign up with an ACA health plan, and Virginia ADAP pays the premiums, deductibles, and medication copays.

The two-year study involved 3,933 people living with HIV in Virginia who qualified for one of the ADAP programs. Of the nearly 4,000 individuals in the study, 47 percent (1,849) enrolled in ACA plans while 53 percent (2,084) received care directly through ADAP. Comparing the health outcomes of the two groups, researchers learned that viral suppression was achieved by 86 percent of those enrolled in the ACA, while the other ADAP care group only had a 79 percent success rate.

ACA insurance shifted the expense of HIV medications from the ADAP, which also left more money for the state so it could cover other people living with HIV. Before the ACA option was available, direct ADAP often had a waitlist due to limited resources but now even more individuals are getting their health care needs covered.

“Moving patients to ACA insurance helps the Virginia ADAP use federal and state funds to cover a larger number of patients and help avoid waitlists for medications and services,” McManus explained.

While eligibility rules and coverage differ, every state has their own ADAP program, and all are safety nets for people with HIV. In fact, one-third of the U.S. population living with HIV receive their medications through a state-funded ADAP program

Transfering more of them to ACA insurance could play an important step in reaching viral suppression goals, while leaving more money in ADAP to help others in need.

“We believe enrolling patients in ACA health plans would help ADAP clients in states without Medicaid expansion and those in states with Medicaid expansion who still do not qualify for Medicaid, but are struggling to afford care,” McManus concluded.