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Medicaid Expansion States Made Largest Veterans’ Health Coverage Gains

Uninsurance among non-elderly veterans fell from 9.6 percent in 2013 to 5.9 percent in 2015 as the major coverage provisions of the Affordable Care Act (ACA) took effect, a new Urban Institute report finds.  The gains were greatest in states that expanded Medicaid.

The share of veterans without health insurance fell by 4.3 percentage points in states that expanded Medicaid between 2013 and 2015, but by 3.3 percentage points in non-expansion states. 

The Urban Institute’s new findings, which are based on analysis of American Community Survey (ACS) data, are in line with the analysis it conducted last fall off the Centers for Disease Control and Prevention’s National Health Interview Survey data.  Using ACS’ more precise data allowed the Urban researchers to capture sufficiently large sample sizes and produce statistically valid results in most states.  Nine of the ten states with the largest percentage-point drops in the uninsured rate among veterans were expansion states (see table).

Medicaid Expansion States Saw Greatest Gains in Vets' Health Coverage
State Veterans’ Uninsured Rate (2013) Veterans’ Uninsured Rate (2015) Percentage-Point Change
Oregon 12.1% 4.4% -7.8
Arkansas 14.8% 8.2% -6.5
Nevada 11.6% 5.4% -6.2
Kentucky 10.3% 4.2% -6
Washington 9.6% 4.2% -5.4
Florida* 12.5% 7.4% -5.2
California 9.3% 4.6% -4.8
Arizona 9.9% 5.4% -4.5
Indiana 11.5% 7.2% -4.3
New Jersey 8.9% 4.6% -4.3
Average expansion state 9.0% 4.8% -4.3
Average non-expansion state 10.3% 7.1% -3.3

*Florida has not expanded Medicaid under the Affordable Care Act.

Source: Urban Institute analysis of 2013-2015 American Community Survey data

In addition, most of the country’s estimated remaining 429,000 uninsured veterans have income that would make them eligible for either tax credits to purchase coverage in the ACA’s marketplace or Medicaid expansion coverage — but many live in non-expansion states.  (Only 2 percent of veterans with income above these thresholds are uninsured.) 

To make further progress in extending health coverage to more uninsured veterans: the 19 states that have not expanded Medicaid should do so, House Republicans should drop their efforts to repeal the ACA and instead focus on enrolling more veterans in Medicaid and the marketplace subsidies for which they qualify, and policymakers should increase resources for the Department of Veterans Affairs so that it can better meet the needs of veterans.