Transcript Population Distribution by Race/Ethnicity and Geographic

HIV in the Southern United States:
Regional Challenges & Opportunities
Jen Kates, PhD
Vice President; Director, Global Health & HIV Policy
Kaiser Family Foundation
[email protected]
http://kff.org/hivaids
June 18, 2014
Figure 1
Census Regions and Divisions of the United States
Northeast
Midwest
(9 states)
(12 states)
VT
WA
ND
MT
OR
West
WI
WY
(13 states)
UT
CO
CA
AZ
NM
PA
IL
KS
OH
IN
WV
MO
KY
OK
AR
TX
AL
VA
SC
GA
LA
FL
HI
South
(17 states, including DC)
SOURCE: United States Census Bureau. http://www.census.gov/geo/maps-data/maps/pdfs/reference/us_regdiv.pdf
MA
CT RI
NJ
DE
MD
NC
TN
MS
AK
NY
MI
IA
NE
NV
NH
MN
SD
ID
ME
DC
Figure 2
The Southern Region of the United States: Broader
Considerations & Context Beyond HIV
• The southern region represents more than a third (37%) of the
U.S. population:
100%
– Largest share of any census region
– Its population is growing rapidly
82%
– Its population is racially/ethnically
diverse
• The South has faced longstanding disparities
in health coverage,
Leading
health status, and health care. Relativeroleto the rest of the United
States, Southerners are:
– More likely to be poor
– More likely to be uninsured
– Less likely to have access to needed health
Major role,
services
but
(e.g., no usual
leading
source of care, postponing care due tonot
cost)
– More likely to report poor health and experience a number of chronic
health conditions
– More likely to live in areas with a shortage of primary care providers
SOURCE: Stephens J, Artiga S, Paradise J, Health Coverage and Care in the South in 2014 and Beyond, Kaiser Family Foundation, April 2014.
Figure 3
Key ACA Provisions for People with HIV
CONSUMER
PROTECTIONS
HEALTH CARE
MARKETPLACES
IN EVERY STATE
MEDICAID
EXPANSION
BENEFITS
STANDARDS,
INCLUDING
PREVENTION
Figure 4
Most Southern States (11 of 17) are Not Implementing
Medicaid Expansion in 2014
36% PLWHA
Live in the 11
Southern States
Not Expanding
DE
MD
WV
VA
KY
DC
NC
TN
OK
SC
AR
MS
TX
AL
GA
LA
FL
In These 11
States, There is
no Medicaid
Coverage of
Childless Adults,
Regardless of
Income
Implementing Expansion (6 states, including DC)
Not Expanding (11 States)
NOTES: Eligibility as of January 2014 and Medicaid expansion data as of March 26, 2014..
SOURCES: States implementing in 2014 and not moving forward at this time are based on data from CMS here.
Figure 5
Uninsured Rates in the South Vary by State; Half Had Rates
at or Above the U.S. Average (Pre-2014)
27%
United States: 18%
The South: 21%
25%
22%
22%
21%
20%
20%
19%
18%
17%
17%
16%
16%
15%
15%
12%
9%
TX
FL
LA
GA
AR
OK
NC
SC
MS
NOTE: Uninsured rates among nonelderly southerners, 2011-2012.
SOURCE: KCMU/Urban Institute analysis of 2013 and 2012 ASEC Supplements to the CPS.
WV
KY
AL
TN
VA
MD
DE
DC
Figure 6
And, Most Southern States Not Expanding Medicaid Have
Higher than Average Uninsured Rates
27%
25%
22%
22%
21%
20%
20%
19%
Expanding
Not Expanding
18%
17%
17%
16%
16%
15%
15%
12%
9%
TX
FL
LA
GA
AR
OK
NC
SC
MS
WV
KY
AL
TN
VA
MD
NOTE: Uninsured rates among nonelderly southerners, 2011-2012.
SOURCE: KCMU/Urban Institute analysis of 2013 and 2012 ASEC Supplements to the CPS; States implementing in 2014 and not moving forward at this time
are based on data from CMS here.
DE
DC
Figure 7
Most Uninsured Individuals with HIV are Low Income; Half
Have Incomes < 100% FPL
100-138% FPL
16%
<100% FPL
51%
139-399% FPL
29%
400% FPL+
4%
FPL=Federal Poverty Level. The FPL in 2009 was $10,830 for an individual.
NOTES: May not total 100% due to rounding. Non-elderly people with HIV in care, 2009. N = 69,720.
SOURCE: Kates J, Garfield R, Young K, Quinn K, Frazier E, Skarbinski J, Assessing the Impact of the Affordable Care Act on Health Insurance Coverage of People
with HIV, Kaiser Family Foundation, January 2014.
Figure 8
Most Uninsured Individuals with HIV are Low Income; Half
Have Incomes < 100% FPL
100-138% FPL
16%
“Coverage
Gap”
in NonExpansion
States
<100% FPL
51%
139-399% FPL
29%
400% FPL+
4%
FPL=Federal Poverty Level. The FPL in 2009 was $10,830 for an individual.
NOTES: May not total 100% due to rounding. Non-elderly people with HIV in care, 2009. N = 69,720.
SOURCE: Kates J, Garfield R, Young K, Quinn K, Frazier E, Skarbinski J, Assessing the Impact of the Affordable Care Act on Health Insurance Coverage of People
with HIV, Kaiser Family Foundation, January 2014.
Figure 9
Looking Ahead: Challenges & Opportunities
• The South is a populous, diverse region, but one that has faced
historical barriers to access, including for people with HIV
100%
• ACA offers new opportunities for insurance coverage and access
– New consumer protections and benefit standards nationwide
82%
– Health care marketplaces in all 17 southern states
– Medicaid expansion in 6 southern states
Leading
role
• Yet, in the 11 southern states not expanding Medicaid, uninsured,
low income, people with HIV likely to be in the “coverage gap”
• In all health care marketplaces, it will be important to monitor
qualified health plans for:
role,
but
– Benefit packages and costs, includingMajor
drug
tiering
not leading
– Provider networks
• Ryan White will continue to be critical in all 17 southern states,
particularly in those not expanding Medicaid
• ACA implementation is still a work in progress