On this Memorial Day, as we honor the sacrifices of those who gave their lives serving in the US Armed Forces, it is also important to remember the living veterans and to assess how well the nation is meeting their health needs.
Despite much-stated public concern for the health and well-being of veterans, according to the American Community Survey (ACS), 1 in 10 non-elderly veterans did not have any health insurance coverage as recently as 2013 (Figure 1) (See Note 1).
One In Ten Veterans Were Uninsured Pre-ACA
The uninsured rate found for veterans in 2013 is very similar to the rate that prevailed in the 2008-2010 period (See Note 2). Uninsurance is lower among veterans relative to the general population in part based on the availability of care through the Veterans Affairs (VA) system, which provides health care for veterans through a system of clinics and hospitals.
However, some veterans may not use VA services because they live far from providers, do not meet eligibility criteria, or do not know they qualify for VA care, among other reasons. Like the general population, non-elderly veterans who are younger, unmarried, less educated, and poorer are less likely to have coverage. For example, about 1 in 4 non-elderly veterans below the federal poverty level (FPL) lacked health insurance coverage of any type in 2013, according to the ACS.
Many Veterans Aren’t Getting The Care They Need
Uninsured veterans report much lower access to needed health care than insured veterans. According to the 2012-2013 National Health Interview Survey (NHIS), uninsured veterans are much more likely to report having unmet health needs and to have delayed care due to cost than veterans with insurance coverage (Figure 2). Over 40 percent of uninsured veterans report having an unmet health need, 3 in 10 have unmet dental needs, and over a third have delayed needed care due to cost, much higher than among veterans with insurance coverage.
In addition, both insured and uninsured veterans report high levels of health problems. Over 4 in 10 in both groups have a chronic health condition, and about 15 percent in both groups are reported to be in fair or poor health, according to the NHIS. By comparison, about 30 percent of non-veteran adults have a chronic health condition and 10 percent are reported to be in fair or poor health (data not shown). And, there is evidence from other research of higher suicide rates particularly among younger veterans, with veterans overall reportedly accounting for as many as one in five suicides in the United States, or an average of 22 veteran suicides per day, according to the VA.
Can The Affordable Care Act (ACA) Help Address Veterans’ Coverage And Service Gaps?
The major coverage provisions of the ACA that were implemented in 2014 have the potential to reduce coverage and access gaps among veterans. Many veterans now qualify for new financial assistance for health insurance coverage through Medicaid or the Marketplace, and some uninsured veterans may newly enroll in VA care.
However, the coverage impacts of the ACA will likely not be uniform for veterans across the country. Half of the nation’s poor veterans lived in one of the 22 states that had not expanded Medicaid as of May 2015 (See Note 3) and uninsured rates were slightly higher pre-ACA among poor veterans in states that have not expanded Medicaid than in Medicaid expansion states (28.6 percent versus 24.5 percent, data not shown). Since most uninsured veterans living below the FPL will qualify for Mediciad only if their state expands Medicaid under the ACA, this gap leaves many poor veterans without new affordable coverage options.
Variation across states in types of Marketplaces and levels of enrollment assistance could also affect coverage patterns across states. Enrollment in both Medicaid and Marketplace coverage has varied across states, as have reductions in uninsurance, suggesting that uninsured veterans may be gaining coverage at different rates across the country.
But addressing access barriers will require more than reducing uninsurance among veterans — it will also be necessary to ensure that coverage can be translated into high-quality, timely care. Recent legislation to address long wait times and other barriers to care for veterans in some VA locations could increase access to effective care for VA enrollees, as could efforts to improve mental health care for veterans.
As the ACA is being implemented, there is potential for narrowing coverage, access, and affordability gaps and improving the health and functioning of veterans. It will be important to assess the extent to which that promise is being fulfilled for America’s veterans in order to identify remaining gaps and develop appropriate policy responses.
Ensuring that no veteran lacks access to the health care they need seems a fitting way to honor the sacrifice of all of those who have served.
Note 1
Uninsurance is defined as lacking comprehensive insurance coverage and also not using Veterans’ Affairs (VA) health care. Urban Institute tabulations of the 2013 ACS indicate that 8.3% of non-elderly veterans reported that they relied on only VA health care and had no other source of insurance coverage. Estimates of uninsurance also reflect an adjustment for the misreporting of coverage on the ACS.
Note 2
Changes in the question on veteran status in the 2013 ACS resulted in fewer total veterans identified in the survey than in prior years, and as a result, the total number of uninsured veterans we estimate for 2013 is lower than for previous years (980,000 in 2013 vs. 1.2 million in 2012 and 1.3 million in 2010). In contrast, the estimated uninsured rate among veterans remained fairly stable despite the change in the sample of veterans identified on the ACS.
Note 3
We treat Montana as a nonexpansion state since it had not begun implementation as of May 2015.
No comments:
Post a Comment