Andrew Edmonds1, Nadya Belenky2, Adebola A Adedimeji3, Mardge H Cohen4, Gina Wingood5, Margaret A Fischl6, Elizabeth T Golub7, Mallory O Johnson8, Daniel Merenstein9, Joel Milam10, Deborah Konkle-Parker11, Tracey E Wilson12, Adaora A Adimora13. 1. Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Electronic address: aedmonds@email.unc.edu. 2. RTI International, Research Triangle Park, North Carolina. 3. Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York. 4. Department of Medicine, Stroger Hospital, Cook County Bureau of Health Services, Chicago, Illinois. 5. Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York. 6. Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida. 7. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 8. Department of Medicine, University of California, San Francisco, San Francisco, California. 9. Department of Family Medicine, Georgetown University Medical Center, Washington, District of Columbia. 10. Department of Epidemiology and Biostatistics, Susan & Henry Samueli College of Health Sciences, University of California, Irvine, Irvine, California. 11. Department of Medicine, The University of Mississippi Medical Center, Jackson, Mississippi. 12. Department of Community Health Sciences, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, New York. 13. Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Division of Infectious Diseases, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Abstract
BACKGROUND: As employment, financial status, and residential location change, people can gain, lose, or switch health insurance coverage, which may affect care access and health. Among Women's Interagency HIV Study participants with HIV and participants at risk for HIV attending semiannual visits at 10 U.S. sites, we examined whether the prevalence of coverage types and rates of coverage changes differed by HIV status and Medicaid expansion in their states of residence. METHODS: Geocoded addresses were merged with dates of Medicaid expansion to indicate, at each visit, whether women lived in Medicaid expansion states. Age-adjusted rate ratios (RRs) and rate differences of self-reported insurance changes were estimated by Poisson regression. RESULTS: From 2008 to 2018, 3,341 women (67% Black, 71% with HIV) contributed 43,329 visits at aged less than 65 years (27% under Medicaid expansion). Women with and women without HIV differed in their proportions of visits at which no coverage (14% vs. 19%; p < .001) and Medicaid enrollment (61% vs. 51%; p < .001) were reported. Women in Medicaid expansion states reported no coverage and Medicaid enrollment at 4% and 69% of visits, respectively, compared with 20% and 53% of visits for those in nonexpansion states. Women with HIV had a lower rate of losing coverage than those without HIV (RR, 0.81; 95% confidence interval [CI], 0.70 to 0.95). Compared with nonexpansion, Medicaid expansion was associated with lower coverage loss (RR, 0.62; 95% CI, 0.53 to 0.72) and greater coverage gain (RR, 2.32; 95% CI, 2.02 to 2.67), with no differences by HIV status. CONCLUSIONS: Both women with HIV and women at high risk for HIV in Medicaid expansion states had lower coverage loss and greater coverage gain; therefore, Medicaid expansion throughout the United States should be expected to stabilize insurance for women and improve downstream health outcomes.
BACKGROUND: As employment, financial status, and residential location change, people can gain, lose, or switch health insurance coverage, which may affect care access and health. Among Women's Interagency HIV Study participants with HIV and participants at risk for HIV attending semiannual visits at 10 U.S. sites, we examined whether the prevalence of coverage types and rates of coverage changes differed by HIV status and Medicaid expansion in their states of residence. METHODS: Geocoded addresses were merged with dates of Medicaid expansion to indicate, at each visit, whether women lived in Medicaid expansion states. Age-adjusted rate ratios (RRs) and rate differences of self-reported insurance changes were estimated by Poisson regression. RESULTS: From 2008 to 2018, 3,341 women (67% Black, 71% with HIV) contributed 43,329 visits at aged less than 65 years (27% under Medicaid expansion). Women with and women without HIV differed in their proportions of visits at which no coverage (14% vs. 19%; p < .001) and Medicaid enrollment (61% vs. 51%; p < .001) were reported. Women in Medicaid expansion states reported no coverage and Medicaid enrollment at 4% and 69% of visits, respectively, compared with 20% and 53% of visits for those in nonexpansion states. Women with HIV had a lower rate of losing coverage than those without HIV (RR, 0.81; 95% confidence interval [CI], 0.70 to 0.95). Compared with nonexpansion, Medicaid expansion was associated with lower coverage loss (RR, 0.62; 95% CI, 0.53 to 0.72) and greater coverage gain (RR, 2.32; 95% CI, 2.02 to 2.67), with no differences by HIV status. CONCLUSIONS: Both women with HIV and women at high risk for HIV in Medicaid expansion states had lower coverage loss and greater coverage gain; therefore, Medicaid expansion throughout the United States should be expected to stabilize insurance for women and improve downstream health outcomes.
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Authors: Adaora A Adimora; Catalina Ramirez; Lorie Benning; Ruth M Greenblatt; Mirjam-Colette Kempf; Phyllis C Tien; Seble G Kassaye; Kathryn Anastos; Mardge Cohen; Howard Minkoff; Gina Wingood; Igho Ofotokun; Margaret A Fischl; Stephen Gange Journal: Int J Epidemiol Date: 2018-04-01 Impact factor: 7.196
Authors: Emma Sophia Kay; Andrew Edmonds; Christina Ludema; Adaora Adimora; Maria L Alcaide; Aruna Chandran; Mardge H Cohen; Mallory O Johnson; Seble Kassaye; Mirjam-Colette Kempf; Caitlin A Moran; Oluwakemi Sosanya; Tracey E Wilson Journal: AIDS Care Date: 2020-11-25