Repealing ACA would leave more veterans uninsured, increase pressure on VASeptember 14, 2017
Proposals to repeal or replace the federal Affordable Care Act would likely increase the demand for service in the Veterans Affairs medical system, while also increasing the number of veterans who have no insurance coverage at all, according to a new RAND Corporation report.
Under legislation passed by the U.S. House of Representatives, health coverage losses among nonelderly veterans would be concentrated among older, low-income and less-healthy veterans, according to the study.
These groups of veterans are more likely than other nonelderly veterans to obtain care from the VA medical system, magnifying the potential impact of ACA repeal on demand for VA care.
"Repealing or significantly scaling back the Affordable Care Act is likely to increase the number of uninsured veterans," said Michael Dworsky, the study's lead author and an economist at RAND, a nonprofit research organization. "Some veterans who lose health insurance coverage as a result of ACA repeal will become more likely to seek care from the VA health system, leading to additional strain on a health care system that already faces challenges in ensuring adequate capacity."
Veterans are less likely to be uninsured than similar nonveterans, in large part because many have access to VA health care. As of 2013, just before the ACA's major coverage expansions took effect, 1 in 10 nonelderly veterans was uninsured and did not report having VA coverage.
RAND researchers estimate that just under three in five nonelderly veterans were eligible for VA care in 2015, and not all who are eligible choose to enroll. Veterans generally qualify for VA health benefits if they have served for at least two years, have an other-than-dishonorable discharge, served during wartime or in combat, have a health condition connected to military services or have a low income.
Veterans who enroll in the VA health system may choose to use other sources of care for a variety of reasons, including accessibility of care, perceived quality of care and costs. Even veterans who use the VA health system receive the majority of their health care from sources outside the VA system. Changes in non-VA insurance status are thus likely to affect VA use.
RAND researchers assessed the likely effects of changes to the ACA by examining how many military veterans gained coverage under the law and their sources of health care coverage. They then modeled how proposed changes to the ACA would have affected coverage of veterans if the changes had been imposed on the veteran population that existed in 2015.
The analysis broadly considered many of the changes proposed in both the American Health Care Act (passed by the House of Representatives) and the Better Care Reconciliation Act (rejected by the Senate), including reforms to the individual market and conversion of federal Medicaid funding to a capped allocation.
RAND researchers found that the ACA reduced both the number of uninsured veterans and the number of VA-covered veterans who lacked non-VA insurance. They also estimate that the proportion of uninsured nonelderly veterans fell by about one-third after adoption of the Affordable Care Act, dropping from 9.1 percent in 2013 to 5.8 percent in 2015.
The demographics of the nonelderly VA population are changing rapidly, with many Vietnam-era veterans aging into Medicare while the number of veterans with service in the post-9/11 era increases. VA policy also was changing rapidly over this time period.
RAND researchers also estimated how state Medicaid expansion decisions affected veterans' insurance status. They found that Medicaid expansion substantially increased insurance coverage for low-income veterans in the income range targeted by Medicaid expansion.
The effects on veterans and the VA of ACA repeal would vary across states. The largest impacts would be felt in states that expanded Medicaid, but differences between states in the age structure and income level of the veteran population also matter for determining which states are most exposed to ACA repeal. The increase in use of VA services due to ACA repeal would be lowest in Nebraska and largest in Arkansas.
The report, "Veterans' Health Insurance Coverage Under the Affordable Care Act and Implications of Repeal for the Department of Veterans Affairs" is available at http://www.rand.org. Other authors of the report are Carrie Farmer and Mimi Shen.
RAND Health is the nation's largest independent health policy research program, with a broad research portfolio that focuses on health care costs, quality and public health preparedness, among other topics.
Related Health Care Articles:
Pesearchers at Partners HealthCare published a study showing that Partners Pioneer ACO not only reduces spending growth, but does this by reducing avoidable hospitalizations for patients with elevated but modifiable risks.
According to a newly released NEJM Catalyst Insights Report, health care executives and industry insiders expect patients -- more than any other stakeholder -- to be the big losers of any comprehensive health care plan from the Trump administration.
Marking six years since the start of the Syrian conflict (15 March), a study in The Lancet provides new estimates for the number of medical personnel killed: 814 from March 2011 to February 2017.
The January issue of Health Affairs includes a study that explores a much-discussed issue in global health: the role of governance in improving health, which is widely recognized as necessary but is difficult to tie to actual outcomes.
Global lung cancer researchers and patient advocates today emphasized that new models of delivering care and communicating about cancer care play an important role in the fight against lung cancer.
Texas has experienced a roughly 6 percentage-point increase in health insurance coverage from the Affordable Care Act, according to new research by experts at Rice University and the Episcopal Health Foundation.
Training informal health-care providers in India improved the quality of health care they offered to patients in rural regions, a new study reports.
The Affordable Care Act has substantially decreased the number of uninsured Americans and improved access to health care, though insurance affordability and disparities by geography, race/ethnicity, and income persist.
Among adults enrolled in an integrated health care system, receipt of primary care at integrated team-based care practices compared with traditional practice management practices was associated with higher rates of some measures of quality of care, lower rates for some measures of acute care utilization, and lower actual payments received by the delivery system, according to a study appearing in the Aug.
The quality of health care provided to US military veterans in Veterans Affairs (VA) facilities compares favorably with the treatment and services delivered outside the VA.
Related Health Care Reading:
The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care
by T. R. Reid (Author)
A New York Times Bestseller, with an updated explanation of the 2010 Health Reform Bill
Bringing to bear his talent for explaining complex issues in a clear, engaging way, New York Times bestselling author T. R. Reid visits industrialized democracies around the world--France, Britain, Germany, Japan, and beyond--to provide a revelatory tour of successful, affordable universal health care systems. Now updated with new statistics and a plain-English explanation of the 2010 health care reform bill, The Healing of America is required reading for all those... View Details
An American Sickness: How Healthcare Became Big Business and How You Can Take It Back
by Elisabeth Rosenthal (Author)
A New York Times bestseller
A Washington Post Notable Book of the Year
At a moment of drastic political upheaval, An American Sickness is a shocking investigation into our dysfunctional healthcare system - and offers practical solutions to its myriad problems.
In these troubled times, perhaps no institution has unraveled more quickly and more completely than American medicine. In only a few decades, the medical system has been overrun by organizations seeking to exploit for profit the trust that vulnerable and sick Americans place in... View Details
The American Health Care Paradox: Why Spending More is Getting Us Less
by Elizabeth H. Bradley (Author), Lauren A. Taylor (Author), Harvey V. Fineberg (Foreword)
Foreword by Harvey V. Fineberg, President of the Institute of Medicine
For decades, experts have puzzled over why the US spends more on health care but suffers poorer outcomes than other industrialized nations. Now Elizabeth H. Bradley and Lauren A. Taylor marshal extensive research, including a comparative study of health care data from thirty countries, and get to the root of this paradox: We've left out of our tally the most impactful expenditures countries make to improve the health of their populationsinvestments in social services.
In The American Health Care... View Details
Policy & Politics in Nursing and Health Care, 7e (Policy and Politics in Nursing and Health)
by Diana J. Mason RN PhD FAAN (Author), Deborah B Gardner RN PhD FAAN FNAP (Author), Freida Hopkins Outlaw PhD RN FAAN (Author), Eileen T. O'Grady PhD RN ANP (Author)
Featuring analysis of cutting-edge healthcare issues and first-person stories, Policy & Politics in Nursing and Health Care, 7th Edition is the leader in helping students develop skills in influencing policy in today’s changing health care environment. Approximately 150 expert contributors present a wide range of topics in this classic text, providing a more complete background than can be found in any other policy textbook on the market. Discussions include the latest updates on conflict management, health economics, lobbying, the use of media, and working with communities for... View Details
The Strategic Management of Health Care Organizations
by Peter M. Ginter (Author)
A structured strategic management approach is what’s needed to tackle the revolutionary change the health care system has been experiencing. Today, health care organizations have almost universally embraced the strategic perspective first developed in the business sector and now have developed strategic management processes that are uniquely their own. Health care leaders have found that strategic thinking, planning, and managing strategic momentum are essential for coping with the dynamics of the health care industry. Strategic Management has become the single clearest manifestation of... View Details
Motivational Interviewing in Health Care: Helping Patients Change Behavior (Applications of Motivational Interviewing)
by Stephen Rollnick (Author), William R. Miller (Author), Christopher C. Butler (Author)
Much of health care today involves helping patients manage conditions whose outcomes can be greatly influenced by lifestyle or behavior change. Written specifically for health care professionals, this concise book presents powerful tools to enhance communication with patients and guide them in making choices to improve their health, from weight loss, exercise, and smoking cessation, to medication adherence and safer sex practices. Engaging dialogues and vignettes bring to life the core skills of motivational interviewing (MI) and show how to incorporate this brief evidence-based approach... View Details
Delivering Health Care in America: A Systems Approach
by Leiyu Shi (Author), Douglas A. Singh (Author)
Delivering Health Care in America, Seventh Edition is the most current and comprehensive overview of the basic structures and operations of the U.S. health system--from its historical origins and resources, to its individual services, cost, and quality. Using a unique "systems" approach, the text brings together an extraordinary breadth of information into a highly accessible, easy-to-read resource that clarifies the complexities of health care organization and finance while presenting a solid overview of how the various components fit together.
With updated data and figures throughout,... View Details
Introduction to Health Care Management
by Sharon B. Buchbinder (Author), Nancy H. Shanks (Author)
Introduction to Health Care Management, Third Edition is a concise, reader-friendly, introductory healthcare management text that covers a wide variety of healthcare settings, from hospitals to nursing homes and clinics. Filled with examples to engage the reader's imagination, the important issues in healthcare management, such as ethics, cost management, strategic planning and marketing, information technology, and human resources, are all thoroughly covered.
Guidelines and rubrics along with numerous case studies make this text both student-friendly and teacher-friendly. It is the... View Details
Guide to Culturally Competent Health Care
by Larry D. Purnell PhD RN FAAN (Author)
Be prepared for the culturally rich and diverse world of healthcare!
This concise, easy-to-read handbook prepares you to relate to individuals from different cultures. Use it in class and clinical now and as a reference throughout your career.
The Purnell Model is your guide as you explore 34 different cultures and the issues that you need to be sensitive to…including cultural variations regarding personal space, dietary preferences, communication, symptom management, activities of daily living, and religious and health practices.View Details
Essentials of the U.S. Health Care System
by Leiyu Shi (Author), Douglas A. Singh (Author)
Essentials of the U.S. Health Care System, Fourth Edition is a clear and concise distillation of the major topics covered in the best-selling Delivering Health Care in America by the same authors. Designed for undergraduate and graduate students in programs across the health disciplines, Essentials of the U.S. Health Care System is a reader-friendly, well organized resource that covers the major characteristics, foundations, and future of the U.S. health care system. The text clarifies the complexities of health care organization and finance and presents a solid overview of how the various... View Details