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  International AIDS Conference
Durban, South Africa
July 18-22 2016
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Only 60% of HIV Providers Can Answer 4 Easy Questions About Obamacare - National Survey of United States HIV Healthcare Providers about Affordable Care Act Knowledge and Attitudes
  21st International AIDS Conference (AIDS 2016), July 18-22, 2016, Durban, South Africa
Mark Mascolini
Only about 60% of HIV providers in a national US survey could correctly answer four simple question about the Affordable Care Act (ACA, Obamacare), the federal program to help people find health insurance [1]. Providers who believed the ACA will positively affect health outcomes had a better understanding of how the program works.
The ACA is a controversial US statute that has expanded health insurance coverage across the United States. University of Virginia researchers who conducted the new survey noted that provider understanding of how the ACA works with existing HIV support programs (the Ryan White CARE Act and the AIDS Drug Assistance Program) is crucial to optimal coverage for many people with HIV.
The research team emailed HIV providers associated with an infectious disease fellowship training program and gave them a weblink to the survey. The survey asked four questions about how the ACA works, including whether it eliminates the Ryan White program and whether the respondent's state agreed to accept the ACA's optional Medicaid expansion.* Three statements assessed providers' attitudes about the ACA's impact on HIV patient outcomes.*
The 253 survey respondents from 35 states and Washington, DC included attending physicians (66% of respondents), fellow physicians (16%), nurse practitioners (14%), and physician assistants (4%). While 28.5% of respondents had more than 20 years of clinical experience, 29.6% had 5 or fewer years of experience. Two thirds of respondents got their information about the ACA from newspapers or magazines or from the Web, while about half also got information from clinic case managers or social workers or from television.
Most respondents, 61%, answered all four ACA knowledge questions correctly, and another 23% answered three of four questions correctly. The remaining participants got two, one, or no answers right. On a scale of 1 through 5 (from strongly disagree to strongly agree) for statements on whether the ACA will positively affect health outcomes,* providers in Medicaid expansion states averaged a nonsignificantly higher agreement rate than providers in nonexpansion states (4.08 versus 3.78). For the question on whether the ACA will positively affect patients' HIV outcomes (statement 2 in the list below*), providers in Medicaid expansion had a significantly higher agreement rate than providers in nonexpansion states (3.78 versus 3.37, P = 0.002).
Multivariate analysis exploring associations with correct ACA knowledge adjusted for years of clinical experience, sources of ACA information, and attitudes about the ACA. Having a more positive attitude about the ACA's impact almost tripled chances of correct ACA knowledge (aOR 2.81, 95% CI 1.58 to 5.02, P < 0.001). Practicing in a Medicaid expansion state more than doubled the odds of correct ACA knowledge (adjusted odds ratio [aOR] 2.57, 95% confidence interval [CI] 1.30 to 5.10, P = 0.007). Learning about the ACA in four ways more than doubled the odds of correct ACA knowledge: from clinic case managers (aOR 2.88, 95% CI 1.35 to 6.13, P = 0.006), from radio (aOR 2.31, 95% CI 1.02 to 5.23, P = 0.044), from newspapers or magazines (aOR 2.20, 95% CI 1.00 to 4.81, P = 0.049), and from websites (aOR 2.12, 95% CI 1.00 to 4.50, P = 0.050).
1. McManus KA, McManus KR, Dillingham R. National survey of United States HIV healthcare providers about Affordable Care Act knowledge and attitudes. 21st International AIDS Conference (AIDS 2016). July 18-22, 2016. Durban, South Africa. Abstract TUPEE517.
*The four knowledge questions were (1) Does the ACA provide subsidies for people with low incomes to purchase health insurance? (2) Does the ACA make it illegal to exclude a person from an insurance plan due to a pre-existing condition? (3) Does the ACA eliminate the Ryan White HIV/AIDS Program? (4) Did your state decide to move forward with the ACA's optional Medicaid expansion? The three attitude statements were (1) The Affordable Care Act will improve the United States' health outcomes. (2) The Affordable Care Act will improve my HIV patients' HIV outcomes. (3) The Affordable Care Act will improve my HIV patients' non-HIV outcomes.