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Health Reform Spurring Big Veterans’ Health Coverage Gains

Veterans are enjoying large gains in health coverage since health reform’s major coverage provisions took effect, as their uninsured rate dropped from 11.9 percent in 2013 to 6.8 percent in 2015, an Urban Institute analysis of the Centers for Disease Control and Prevention’s National Health Interview Survey (NHIS) finds.  The biggest gains have come in states that adopted health reform’s Medicaid expansion, so further state take-up of the expansion will be key to future gains in veterans’ coverage.

Veterans have benefited from expanded coverage in several ways, the NHIS data show.  For example, the share reporting an unmet health need due to cost fell from 7.3 to 4.5 percent between 2013 and 2015.  The share reporting trouble paying medical bills fell from 16.6 to 14.9 percent.

States can do more to improve veterans’ health coverage.  Some 604,000 veterans will be uninsured in 2017, the Urban Institute projects.  Most are in the 19 states that haven’t yet expanded Medicaid, likely because uninsured veterans in non-expansion states are far less likely to have a pathway to coverage.  

For example, 70 percent of uninsured veterans in expansion states qualify for Medicaid or health reform’s tax credits, which help defray the cost of marketplace coverage.  In non-expansion states, only 39 percent of uninsured veterans qualify (see graph).

As a result, many uninsured veterans in non-expansion states are caught in a “coverage gap” — their incomes are too high for Medicaid but too low for marketplace tax credits.  In North Carolina, for example, 49 percent of uninsured veterans are in the coverage gap and would become eligible for Medicaid if their state expanded.  In Florida and Georgia, 44 percent of uninsured veterans would become eligible for Medicaid if their state expanded; in Texas, 33 percent would.

Like the overall population, most veterans get health coverage through their employer, but for those without access to job-based coverage, large gaps exist.  While some veterans receive coverage through the Department of Veterans Affairs (VA) health system, some don’t qualify, some don’t live near a VA facility, and some aren’t aware of VA care.  Health reform’s coverage expansions have helped plug these gaps, but further health coverage gains will depend in large part on whether more states expand Medicaid.