![]() 3, 4 To address these issues, the Patient Protection and Affordable Care Act (ACA) was enacted in 2010 and aimed to expand health insurance coverage and lower the cost of care. 1 An estimated 1 in 4 Americans report difficulty affording medical bills, 2 and healthcare-related expenses are the leading cause of household bankruptcy. Per capita out-of-pocket healthcare expenditures have steadily increased in the USA over the last 50 years. These findings highlight gaps in veterans’ financial protection and areas amenable to policy intervention. ConclusionsĪCA implementation was associated with reduced household catastrophic health expenditures for younger but not older veterans. Major drivers of veterans’ spending post-ACA include dental care, prescription drugs, and home care. In contrast, catastrophic expenditure rates among veterans aged 65+ remained high, at 13.0% pre- and 12.5% post-ACA. This was driven by a 38% decrease in catastrophic spending among veterans with non-VHA coverage (absolute change, −1.8pp 95% CI, −3.0 to −0.6 p=0.003). Key ResultsĪmong veterans aged 18–64, ACA implementation was associated with a 26% decrease in likelihood of catastrophic health expenditures (absolute change, −1.4 percentage points 95% CI, −2.6 to −0.2 p=0.03), which fell from 5.4% pre-ACA to 3.9% post-ACA. Likelihood of catastrophic health expenditures, defined as household out-of-pocket spending exceeding 10% of household income. InterventionĪCA implementation, January 1, 2014. Nationally representative sample of 13,030 veterans aged 18+ from the 2010 to 2017 Medical Expenditure Panel Survey. Among veterans with catastrophic spending post-ACA, we evaluated sources of out-of-pocket spending. Using multivariable linear probability regression, we examined changes in likelihood of catastrophic health spending after ACA implementation, stratifying by age (18–64 vs 65+), household income tercile, and payer (VHA vs non-VHA). To evaluate whether ACA implementation was associated with changes in veterans’ risk of catastrophic health expenditures, and to characterize drivers of catastrophic health spending among veterans post-ACA. The Affordable Care Act (ACA) aimed to expand health insurance access, but its effect on veterans’ financial risk protection has not been explored. ![]() Out-of-pocket healthcare spending thus remains a potential source of financial hardship for veterans. Despite public perception, most of the nearly 20 million US veterans have health coverage outside the Veterans Health Administration (VHA), and VHA eligibility and utilization vary across veterans.
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