The Association between the Affordable Care Act's Medicaid Expansion and New HIV Diagnoses by State, 2012 to 2014 Open Access
Mullin, Shelby (2017)
Abstract
Background
By January 2014, 27 states had expanded Medicaid under the Affordable Care Act to at least 138% of the Federal Poverty Level. This ecological analysis aims to see if there are differing trends in new HIV diagnosis rates in Medicaid expansion and non-expansion states between 2012, before the implementation of the Affordable Care Act, and 2014, after the implementation.
Methods
We assembled a state-level dataset using publicly-available data for HIV and other covariates for the years 2012 and 2014. Linear regression models were used to compare new HIV diagnoses over time in expansion compared to non-expansion states.
Results
In 2012, the mean new HIV diagnosis rate among the expansion states was 15.12 and decreased to 13.67 in 2014 (p = 0.43). Among the non-expansion states, the mean new HIV diagnosis rate was 12.41 in 2012 and slightly increased to 12.82 in 2014 (p = 0.47). The final model (r2 = 0.94) included the 2012 new HIV diagnosis rate measured as a continuous outcome, expansion status measured as a binary outcome, and the interaction variable of the two. The interaction term between the 2012 diagnosis rate and expansion status was statistically significant at the 5% significance level (p = 0.03).
Conclusion
Our final model showed that among states with low rates of new HIV diagnoses, those that did not expand Medicaid on average experienced a decreased rate of new diagnoses whereas states that did expand Medicaid on average experienced an increased rate of new diagnoses. However, among states with high rates of new HIV diagnoses, those states that chose not to expand Medicaid on average experienced an increased rate of new diagnoses whereas states that did expand Medicaid on average experienced a decreased rate of new diagnoses. This initial analysis provided evidence that the effect of Medicaid expansion may vary according to the severity of the initial HIV epidemic in the state.
Table of Contents
Background/Literature Review ....... 1
Methods ....................................7
Results ....................................11
Discussion ................................15
-Limitations ..............................17
-Future Directions .....................18
Tables .....................................25
Figures and Figure Legends .........28
Appendix .................................33
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