Study Examines Potential Impact of Affordable Care Act on Massachusetts Veterans' Enrollment in VA Healthcare
Veterans who enroll in VA can concurrently enroll in and obtain care through other health insurance programs including Medicare, Medicaid, and private insurance. To date, few studies have examined the potential impact of the Affordable Care Act (ACA) on Veterans' enrollment in VA and use of VA healthcare services at the population level. Thus, this study examined the potential impact of ACA on Veterans' enrollment in VA, private insurance, and Medicaid, using the Massachusetts Health Care Reform Act (MHCRA), implemented in June 2006, as a proxy for ACA. Using data from the Current Population Survey (CPS), investigators identified 131,330 Veterans who had answered CPS questions related to health plan coverage during the period 2004-2013. Investigators then compared healthcare enrollment between Veterans residing in Massachusetts and Veterans residing in neighboring New England states (Connecticut, Maine, New Hampshire, Rhode Island, or Vermont) that did not undergo health reform.
- Overall, healthcare reform in Massachusetts was associated with significantly greater Medicaid enrollment, but was not significantly associated with VA and private insurance enrollment. Compared to other Veterans living in New England, Veterans living in Massachusetts decreased their enrollment in VA and private insurance by 0.2 and 0.9 percentage points, respectively, following healthcare reform. By contrast, Medicaid enrollment increased by 2.5 percentage points.
- Veterans increasingly took advantage of the expanded Medicaid options that were part of MHCRA; Veterans who might otherwise have enrolled in VA or private insurance opted for Medicaid.
- Veterans can remain continuously enrolled in VA healthcare regardless of the level of future use, so it is likely that Veterans responding to the CPS equate VA coverage to recent use of VA services. Study findings should be interpreted accordingly.
- Although investigators adjusted for self-reported health, no objective measures of health risk are available in CPS data.
- Enrollment data were ascertained through survey, therefore measures are potentially subject to recall bias.
- Understanding the impact of healthcare reform in Massachusetts is important to inform policymakers about Veterans' likely enrollment in the post-ACA era.
Dr. Wong is supported by an HSR&D Career Development Award, and Dr. Maciejewski is supported by an HSR&D Research Career Scientist Award. Drs. Wong and Hebert are part of HSR&D's Center for Innovation for Veteran-Centered and Value-Drive Care, Seattle, WA; Dr. Maciejewski is part of HSR&D's Center for Health Services Research in Primary Care, Durham, NC.
Wong E, Maciejewski M, Hebert P, et al. Massachusetts Health Reform and Veterans Affairs Health System Enrollment. American Journal of Managed Care. August 2014;20(8):629-36.