Use of VA and Non-VA Health Care after the Affordable Care Act



 DESCRIPTION (provided by applicant): Project background/rationale: In January 2014, the Affordable Care Act (ACA) will increase health insurance options for many non-elderly Veterans (<65 years old). The ACA will allow states to expand Medicaid coverage to all non-elderly individuals with incomes less than 138% of the federal poverty level. Additionally, individuals with incomes from 138% to 400% of the federal poverty level will be eligible to receive premium subsidies for obtaining private health insurance through newly established insurance exchanges. Currently, there are nearly 900,000 non-elderly Veterans whose only source of health insurance coverage is through the Veterans Health Administration (VHA). Over half (52%) of these Veterans (approximately 450,000) have incomes below 138% of the federal poverty level and could be potentially eligible for the Medicaid expansion. An additional 38% (approximately 328,000) have incomes between 138% and 400% of the federal poverty level and could be eligible for premium subsidies for coverage through the insurance exchanges. Consequently, ACA will increase access to non-VA care for a substantial portion of non-elderly Veterans. Understanding the impact of the ACA on Veterans' coverage and use of VA and non-VA care will be crucial for policymaking and planning. Project objectives: The primary aims of this study are to 1) Determine utilization of VA services overall and among priority demographic and clinical subgroups of Veterans following implementation of the ACA; 2) Determine the impact of the ACA on utilization of non-VA services overall and among priority demographic and clinical subgroups of Veterans; and 3) Describe Veterans' ACA insurance enrollment choices and experiences with care coordination immediately following ACA implementation in VISN 12. Project methods: We will use a mixed methods approach and take maximum advantage of available data sources to accomplish our aims. We will use existing VA administrative data to study VA utilization nationwide (Aim 1), leverage a unique database containing healthcare data from multiple Chicago providers to learn about non-VA use among Veterans residing in Chicago (Aim 2), and collect survey and structured interview data to study non-VA utilization and perspectives on insurance enrollment and care coordination among Veterans in VISN 12 (covering diverse populations in rural and urban areas in 4 states: Illinois, Wisconsin, Michigan, and Indiana) (Aims 2 and 3). In collaboration with stakeholders from VISN 12, key high-interest demographic subgroups (rural/urban, VA copayment required, women) and clinical subgroups (mental illness, diabetes with co-existing comorbidities, spinal cord injury/disorder) of Veterans were identified for special focus.