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Area of Science:

  • Health Services Research
  • Health Policy
  • Veterans Health

Background:

  • Affordable Care Act (ACA) provisions expanded health insurance options for nonelderly individuals, including Veterans.
  • These changes potentially impacted enrollment in the Veterans Health Administration (VHA) healthcare system.
  • Understanding these impacts is crucial for VHA resource planning and service delivery.

Purpose of the Study:

  • To compare characteristics of VHA enrollees at three time points relative to ACA implementation.
  • To examine enrollment trends in the VHA before and after key ACA insurance provisions took effect.
  • To assess the influence of the ACA on VHA enrollment dynamics.

Main Methods:

  • Analysis of a 10% sample of VHA enrollees under age 65 (January 2012-September 2015).
  • Comparison of demographic and baseline characteristics across pre-2012, pre-ACA (2012-2013), and post-ACA (2014-2015) enrollment groups.
  • Utilized interrupted time series analysis with pooled logistic regression to evaluate VHA enrollment trends.

Main Results:

  • Post-ACA enrollees were more likely to be older, have service-connected disabilities, and reside farther from VHA centers compared to pre-ACA enrollees.
  • A statistically significant 3% quarterly decline in the odds of new VHA enrollment was observed post-ACA.
  • This enrollment decline was consistent across various demographic and subgroup categories, including sex, geography, and Medicaid expansion status.

Conclusions:

  • The ACA appears to be associated with a decrease in new VHA enrollment.
  • The demographic profile of individuals enrolling in the VHA has shifted post-ACA.
  • Continuous monitoring of VHA enrollment trends is essential for maintaining high-quality and efficient veteran healthcare.