Affordable Care Act Repeal Puts Veterans’ Health Care at Risk

The uninsurance rate among non-elderly veterans has fallen by 42 percent since the major coverage provisions of the Affordable Care Act (ACA) took effect in 2014. Repealing the ACA, as congressional Republicans plan to do, would reverse these substantial coverage gains and exacerbate challenges facing the Department of Veterans Affairs (VA) health system.

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Before those major ACA coverage expansions took effect, 89 percent of uninsured veterans would have been eligible for them based on their income (either the Medicaid expansion that states could adopt or the premium tax credits that help families buy marketplace coverage). Largely because veterans took advantage of these options, their uninsured rate dropped from 11.9 percent in 2013 to 6.8 percent in 2015, according to an Urban Institute analysis of the Centers for Disease Control and Prevention’s National Health Interview Survey (NHIS). States that adopted the Medicaid expansion have experienced the greatest gains. Since health reform took effect, fewer veterans report unmet health needs due to the cost of care, and fewer report trouble paying medical bills.

Many veterans get health services through the VA system, which tailors its services to veterans’ particular health care needs. Not all veterans qualify for VA care and others live far from facilities, which makes it less likely that they can access care through the VA. Like the population as a whole, most veterans get their health coverage through their employer, while others get it through Medicaid or, as of recently, the ACA’s marketplaces. An estimated 3 million veterans who were enrolled in the VA and, thus, were eligible for VA health care, nevertheless get some of their care elsewhere.

Taking health coverage away from veterans by repealing the ACA would shift a greater burden to the VA at a time when the system is short-staffed and veterans are experiencing long wait times to see a doctor. If President Trump and Congress want to do right by veterans’ health care, they should take four critical steps: drop their ACA repeal efforts, make a greater effort to enroll the 318,000 uninsured veterans who are already eligible for ACA coverage, convince more states to expand Medicaid (which would make 124,000 uninsured veterans eligible if all of the 19 states that haven’t expanded Medicaid decided to do so), and increase resources for the VA system so that it can meet the needs of more veterans.