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

 描述(由申请人提供)： 项目背景/理由：2014年1月，《平价医疗法案》(ACA)将增加许多非老年退伍军人(65岁)的医疗保险选择。ACA将允许各州将医疗补助覆盖范围扩大到所有收入低于联邦贫困水平138%的非老年人。此外，收入在联邦贫困水平138%至400%之间的个人将有资格通过新建立的保险交易所获得私人医疗保险的保费补贴。目前，有近90万非老年退伍军人的唯一医疗保险来源是通过退伍军人健康管理局(VHA)。超过一半(52%)的退伍军人(约45万人)的收入低于联邦贫困水平的138%，有可能有资格扩大医疗补助计划。另有38%(约328,000人)的收入在联邦贫困水平的138%至400%之间，有资格通过保险交易所获得保费补贴。因此，ACA将增加相当一部分非老年退伍军人获得非退伍军人护理的机会。了解ACA对退伍军人的覆盖范围和对退伍军人和非退伍军人护理的使用的影响，将对政策制定和规划至关重要。项目目标：本研究的主要目的是：1)确定退伍军人在实施ACA后的总体和优先人口和临床亚群对退伍军人服务的利用；2)确定ACA对退伍军人总体和优先人口和临床亚群对非退伍军人服务的利用的影响；以及3)描述退伍军人在实施ACA后立即进行的ACA保险选择和护理协调经验。项目方法：我们将使用混合方法和最大限度地利用可用的数据源来实现我们的目标。我们将使用现有的退伍军人管理局数据来研究全国退伍军人管理局的使用情况(目标1)，利用一个包含来自多个芝加哥提供商的医疗保健数据的独特数据库来了解居住在芝加哥的退伍军人中非退伍军人的使用情况(目标2)，并收集调查和结构化访谈数据，以研究非退伍军人管理局的使用情况以及VISN 12(覆盖4个州：伊利诺伊州、威斯康星州、密歇根州和印第安纳州)退伍军人的保险登记和护理协调的前景(目标2和3)。与VISN 12的利益攸关方合作，确定了退伍军人的关键高兴趣人口亚群(农村/城市、退伍军人共同支付、妇女)和临床亚群(精神疾病、糖尿病并存、脊髓损伤/障碍)的特别重点。

 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.