The Affordable Care Act, Expanded Insurance Eligibility and Financial Burdens Among Veterans

Bernard, Didem; Bernard, Didem

We compare the financial burden of health care among non-elderly Veterans to non-Veterans by expanded insurance eligibility (Medicaid expansions and premium tax credits in the Health Insurance Marketplaces) under the Affordable Care Act (ACA). The study population includes persons aged 19-64 from a nationally representative sample of the US population from the Medical Expenditure Panel Survey (pooled data from 2005-2010). Non-elderly families are defined as families in which there is at least one person aged 19 to 64 and there are no persons aged older than 64. Veteran family is defined as a family in which there is at least one Veteran aged 19-64. We simulate eligibility for health care benefits from the Department of Veterans Affairs among Veterans. Our main outcome measure is the proportion of non-elderly adults living in families with high out-of-pocket burden, where high burden is defined as spending on health care and insurance premiums >20% of income. Eligibility for Medicaid and premium tax credits in Health Insurance Marketplaces is simulated. Analyses are stratified by whether the state of residence chose to expand Medicaid in 2014. All analyses adjust for the fact that, on average, non-elderly Veterans tend to be older, are more likely to be men. We use iterative proportional fitting (i.e., raking) to adjust the non-Veteran population by age and sex.

Our preliminary results show that among adults living in Veteran families 8.2% were living in families with high burdens. Among adults living in families with Veterans eligible for VA care 14.8% were living in families with high burdens. Among adults living in Veteran families who will be eligible for Medicaid under the ACA in expansion states 26.1% were living in families with high burdens. Among adults living in Veteran families who are ineligible for Medicaid (under 100% FPL) because they live in non-expansion states 26.2% were living in families with high burdens. Among adults living in families with Veterans eligible for VA care who will be eligible for Medicaid under the ACA 32.3% were living in families with high burdens. Among adults living in families with Veterans eligible for VA care who are ineligible for Medicaid (under 100% FPL) because they live in non-expansion states 27.0% were living in families with high burdens.

While we also present results for adults living in non-Veteran families for comparison, we focus on the variation of prevalence of high burdens among adults in Veteran families across expanded insurance eligibility categories under the ACA. The Medicaid expansions under the ACA target precisely those Veterans who had the highest prevalence of high financial burdens due to health care. The ACA will likely reduce the prevalence of high burdens among Veteran families through Medicaid expansion, and also through subsidized coverage in health Insurance Marketplaces through premium subsidies, out-of-pocket spending limits and cost-sharing subsidies. We plan to update our estimates using data from 2011-2014 once 2014 MPS data is available prior to November 2016.

Association for Public Policy Analysis & Management

Panel Paper: The Affordable Care Act, Expanded Insurance Eligibility and Financial Burdens Among Veterans