Veterans' Health Insurance Coverage Under the Affordable Care Act and Implications of Repeal for the Department of Veterans Affairs

Insurance Coverage for Nonelderly Veterans Increased After the ACA

• Insurance coverage gains among nonelderly veterans resulted from Medicaid enrollment due to Medicaid expansion and from increased private coverage, including direct-purchase coverage obtained through the ACA Marketplace.
• Medicaid expansion led to larger coverage increases for low-income veterans living far from VA facilities, suggesting that Medicaid expansion may be particularly helpful to veterans facing barriers to accessing VA.
• The largest reductions in the proportion of veterans without insurance were observed in Medicaid expansion states, particularly Oregon, Arkansas, Nevada, Kentucky, and Washington.

Repealing the ACA Would Increase the Number of Uninsured Nonelderly Veterans and Slightly Increase Demand for VA Health Care

• Without the ACA, nonelderly veterans would have used about 1 percent more VA health care in 2015 — 125,000 more office visits, 1,500 more inpatient surgeries, and 375,000 more prescriptions.
• The American Health Care Act (AHCA) would increase uninsurance among veterans and demand for VA care by a greater margin than simply returning to pre-ACA levels of coverage.
• Reductions in coverage under the AHCA would be concentrated among older, lower-income, and less-healthy nonelderly veterans. These populations of veterans tend to use the most health care from VA, magnifying the increase in VA demand resulting from ACA repeal.
• Other reforms that lead to similar patterns of coverage changes across groups of veterans would likely have a similar impact on VA demand.
• Under the AHCA, Medicaid expansion states with higher proportions of low-income and nonelderly veterans would experience the largest VA demand increases; Arkansas, Kentucky, and Louisiana would experience the largest increases in VA demand relative to total VA use.