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Publication Briefs

Study Suggests Affordable Care Act May Have Significant Implications for Veterans and the VA Healthcare System

The Patient Protection and Affordable Care Act (ACA) represents one of the most significant overhauls of the U.S. healthcare system, but little has been written on the potential impact of the ACA on the health and healthcare of Veterans. Enrollment in VA healthcare satisfies the ACA's requirement for insurance coverage, but eligibility for VA care is determined based on a complex system of priorities (i.e., service-connected disability and income). In addition, major provisions of the ACA include the option for individual states to expand Medicaid coverage, and for the creation of health insurance exchanges, whereby individuals may purchase competitive health insurance plans that are eligible for federal subsidies. Thus, the ACA provides several options for the general public – and for Veterans. Using data from the 2010 National Survey of Veterans, this study sought to: 1) Describe the proportion and characteristics of Veterans currently uninsured, as they will likely be required to obtain coverage; 2) Determine who among the uninsured are likely eligible for the Medicaid expansion (LEME); and 3) Compare the sociodemographics and health characteristics of those uninsured and LEME – and not LEME, and those who currently have health insurance coverage.


  • The ACA is likely to have a considerable impact on uninsured Veterans, which may have implications for VA, the Medicaid expansion, and the health insurance exchanges. Of 22 million Veterans, about 7% – or more than 1.5 million Veterans – were uninsured in 2010 and would need to obtain healthcare coverage by enrolling in VA healthcare, the Medicaid expansion, participating in the health insurance exchanges, or finding some other form of health coverage.
  • Of the uninsured Veterans, more than 800,000 are likely eligible for the Medicaid expansion. However, states that do not implement the Medicaid expansion may have many poor, uninsured Veterans who are not able to afford coverage through the health insurance exchanges because of ineligibility for federal subsidies.
  • Compared to Veterans with health coverage, the uninsured were younger and more likely to be single, African American, low-income, and to have been deployed to Iraq and Afghanistan.
  • Among Veterans who were uninsured, those who were LEME reported poorer general health and were more likely to use emergency department services than Veterans who were not LEME.


  • The projected likelihood of Medicaid eligibility was based on current income.
  • The study had a lack of state-level data, and also relied on self-report measures, including self-reported insurance coverage.
  • Health status was determined using unsophisticated measures, i.e., survey questions asking Veterans to rate their general health on a 5-point scale.

Dr. Tsai was supported by an HSR&D Career Development Award. Drs. Tsai and Rosenheck are part of HSR&D's Pain Research, Informatics, Multi-morbidities, and Education Center in West Haven, CT.

PubMed Logo Tsai J and Rosenheck R. Uninsured Veterans Who Will Need to Obtain Insurance Coverage Under the Affordable Care Act. American Journal of Public Health March 2014;104(3):e57-62.

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What are HSR Publication Briefs?

HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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