为了研究平价医疗法案 (ACA) 政策及其医疗补助扩展对患有侵袭性淋巴瘤的 HIV 患者的保险状况和生存的影响。我们使用国家癌症数据库（一个以医院为基础的国家登记处）来识别 18 岁以下的成年人患有 HIV 相关侵袭性 B 细胞非霍奇金淋巴瘤 (HIV-a-B-NHL) 64 年，于 2007 年至 2016 年期间诊断。对一组可获得位置数据的 HIV-a-B-NHL 患者进行了生存分析。居住在医疗补助扩展通过和未通过的州。使用准实验双重差分模型，比较了采用 ACA 医疗补助扩展的州与未采用扩展的州的灵活参数威布尔模型获得的调整后 2 年生存率的差异。我们确定8,231 名 HIV-a-B-NHL 患者和 50,650 名非 HIV-a-B-NHL 患者。我们发现，与非扩张州相比，扩张州在诊断时没有保险的个人比例较低。我们还发现，ACA 政策的采用导致扩张州未投保的 HIV-a-B-NHL 患者比例降低了 34.9%，而未扩张州的这一比例为 15.9%。与非扩张状态相比，采用 ACA 后，扩张期 HIV-a-B-NHL 患者的 2 年生存率有统计学上的显着改善（7.17% vs 1.58%，P = .02）。 -实验模型中，我们发现，与未扩大医疗补助的州相比，在接受医疗补助扩大的州内，ACA 政策对应于 HIV-a-B-NHL 患者的生存率有更大的改善。我们认为，在未来的政策制定中应考虑到这一证据。

To study the influence of the Affordable Care Act (ACA) policy and its Medicaid expansion on insurance status and survival in patients with HIV with aggressive lymphoma.We used the National Cancer Database, a hospital-based national registry, to identify adults age 18-64 years with HIV-associated aggressive B-cell non-Hodgkin lymphomas (HIV-a-B-NHLs), diagnosed during 2007 to 2016. Survival analysis was performed on a subset of patients with HIV-a-B-NHL for whom location data were available who resided in Medicaid expansion-adopted and nonadopted states. Using a quasi-experimental difference-in-difference model, the difference in adjusted 2-year survival rates obtained with a flexible parametric Weibull model was compared for states that adopted the Medicaid expansion of ACA against those that did not adopt the expansion.We identified 8,231 patients with HIV-a-B-NHL and 50,650 non-HIV patients with a-B-NHL. We found that a lower proportion of individuals were uninsured at diagnosis in the expansion states compared with nonexpansion states. We also found that the ACA policy adoption led to a reduction in the proportion of uninsured individuals with HIV-a-B-NHL in expansion states of 34.9%, compared with 15.9% in non-expansion-adopted states. There was a statistically significant improvement in the 2-year survival rate among patients with HIV-a-B-NHL in the expansion compared with nonexpansion states with the adoption of ACA (7.17% v 1.58%, P = .02).Using a novel quasi-experimental model, we found that the ACA policy corresponded with a greater survival improvement in patients with HIV-a-B-NHL within Medicaid expansion-adopted states compared with nonexpansion states. We believe that this evidence should be taken into consideration in future policy making.