title: Veterans Affairs Health System Enrollment and Health Care Utilization After the Affordable Care Act: Initial Insights.
abstract: The Affordable Care Act (ACA) was signed into law in 2010 and its individual mandate and expanded health care coverage options were implemented in 2014. These provisions may affect Veterans Affairs (VA) enrollment and health care utilization. Using data from two VA regional networks, we examined recent patterns in the number of new VA enrollees and their primary care use. Trends were assessed by enrollment priority group (based on the veteran's severity of service-connected disabilities, exposures, and income level) and a state's Medicaid expansion status. Compared to the same time period in the previous year, the number of new enrollees from low-income priority groups was higher during the open enrollment period and the increase was sharper in Medicaid non-expansion states (25-42%) than in expansion states (20-32%). In addition, low-income patients with a copay requirement who enrolled in the VA during the ACA open enrollment had a lower average number of primary care visits than counterparts who had enrolled in prior time periods (1.73 versus 1.87, p < 0.0001). Although this study is an initial step, more research is required to better understand veterans' decision making and behavior in regard to health care coverage through the ACA and related impacts on VA and non-VA health care utilization and care coordination.
authors.affiliation: Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, 5000 South 5th Avenue, Hines, IL 60141.
authors.forename: Abigail
authors.initials: A
authors.lastname: Silva
authors.affiliation: Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, 5000 South 5th Avenue, Hines, IL 60141.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Tarlov
authors.affiliation: Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, 5000 South 5th Avenue, Hines, IL 60141.
authors.forename: Dustin D
authors.initials: DD
authors.lastname: French
authors.affiliation: Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, 5000 South 5th Avenue, Hines, IL 60141.
authors.forename: Zhiping
authors.initials: Z
authors.lastname: Huo
authors.affiliation: Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, 5000 South 5th Avenue, Hines, IL 60141.
authors.forename: Rachael N
authors.initials: RN
authors.lastname: Martinez
authors.affiliation: Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, 5000 South 5th Avenue, Hines, IL 60141.
authors.forename: Kevin T
authors.initials: KT
authors.lastname: Stroupe
mesh_terms: D006787:Hospitals, Veterans / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000592:standards / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D058991:Patient Protection and Affordable Care Act / Q000706:statistics & numerical data / Q000639:trends; D014481:United States; D014493:United States Department of Veterans Affairs / Q000639:trends*; D014728:Veterans / Q000706:statistics & numerical data*