There’s another effort to repeal and replace ObamaCare going on and at this point, it just reminds me of the old “Batman” TV show. The show would often end by asking viewers about the latest pickle Batman & Robin were in, but of course, you had to tune in next time to get the answers. Only now, in the real world, the questions are more dramatic: How many people will lose coverage? Will pre-existing conditions be covered? Are premiums going up? The only thing that’s missing is a massive cartoon “KA-POW!” on the House floor.
At this point, no one really has answers to these questions and tuning into Congress “next time” won’t give us answers either. Thankfully we have groups like the Rand Corporation to turn to for answers, at least answers to the question of what would happen to the VA’s healthcare should the Affordable Care Act (ACA) get repealed or replaced.
This new study focused on nonelderly veterans or people under the age of 65. This is because anyone 65 or older is usually covered by Medicare, which wasn’t affected by ACA. Nonelderly veterans make up about half of the existing veteran population, so a little more than 10 million people. It’s estimated that out of these veterans, slightly less than 57% were actually eligible for VA care.
In 2013, before the major expansions under the ACA, almost one in ten veterans under the age of 65 were uninsured and didn’t use VA’s healthcare system. After enactment of the ACA, the uninsured number fell 36% from 9.1% to 5.8%. The largest reduction of veterans without insurance were in states that Medicaid expansion, in particular, Oregon, Arkansas, Nevada, Kentucky, and Washington.
The ACA, according to the study, likely had an effect on the number of veterans using VA’s healthcare. It’s estimated that without ACA, nonelderly veterans would have had 125,000 more office visits, 1,500 more inpatient surgeries and received 375,000 more prescriptions from the VA in 2015.
Also in this report, if the American Health Care Act (AHCA) were to become law, the increase in uninsured veterans would grow larger than what it was before there was ACA coverage. With the 2020 AHCA provisions in place, the number of uninsured, nonelderly veterans grows half a percentage point from 9.1 to 9.6. If you look at the 2026 AHCA requirements, 10.4% of veterans under 65 would be without insurance.
That means VA patients would receive less health care overall. 1.7% fewer office visits and prescriptions. All because the nonelderly, uninsured veterans would be tying up the VA by having 245,000 more office visits and getting 910,000 more prescriptions.
Not included in this study is what happens to veterans with preexisting conditions. The AHCA and other, similar legislation, weakens consumer protections that we have with the ACA. This study puts the number of nonelderly veterans with preexisting conditions at 34% once the law is repealed. That number would even be higher when you add in all veterans.
Another key point to this study is that under policy changes proposed by the GOP, states could make changes to benefits, including mental health benefits. A US Army study in 2014 found that veterans faced major forms of depression five times more than civilians. And veterans were 15 times more likely to suffer from PTSD as well. More likely than not, these veterans would turn to the VA for help.
Congress continues to play politics when it comes to healthcare. The authors of this study are optimistic that the results will give leaders a better understanding of how health policy changes outside the VA affects veterans’ health care and hope that Congress will come up with a health care policy that doesn’t create unintended costs for veterans or the VA.