Description: In developing projections, we propose that models of VA healthcare utilization should include factors external to the VA because state Medicaid policy, local economic conditions and non-VA insurance coverage may influence VA use. Using individual-level longitudinal data on annual healthcare utilization ($) by all Veterans nationwide, we estimated change in use of VA healthcare associated with area-level changes in Medicaid eligibility, unemployment rate, housing price index, non-VA provider availability and proportion covered by employer-sponsored health insurance. While most external factors were associated with significant change in utilization, Medicaid policy, employer-sponsored coverage and housing price index had a larger role in recent years. Between 2013 and 2014, Medicaid expansion was associated with a sizable reduction in VA healthcare utilization, predominantly in the states that expanded Medicaid; this change was largely neutralized by increase in VA utilization associated with sizable reduction in employer-sponsored coverage.
Target audience: VA researchers and policy-oriented staff