"It's a Trade off:" Perspectives of Ryan White Social Service Providers on the Implementation of the Affordable Care Act

The Patient Protection and Affordable Care Act (ACA) was expected to reduce health disparities, including among people living with HIV. The aim of this study was to explore experiences of Ryan White HIV/AIDS Program social service providers in a Medicaid-expansion southwestern state. Thematic analysis of semi-structured focus groups revealed that participants view the ACA implementation as posing impossible bureaucratic demands and increasing role conflict. Participants described the ACA impact on clients as "a trade off," with greater medical coverage for some clients, along with increased red tape and challenges for at-risk groups and for their therapeutic alliance with clients. These findings highlight the importance of incorporating the perspectives of providers in planning and implementing policy changes and in measuring the quality of HIV services.