Veterans’ Health

Grantee Name

RAND Corporation

Funding Area

Veterans’ Health

Publication Date

January 2018

Grant Amount


Grant Date:

March 2017 – September 2017

Although the Affordable Care Act (ACA) did not directly affect veterans’ eligibility to enroll in or receive care through the Department of Veterans Affairs (VA), it had important spillover effects for veterans’ health coverage.

Some uninsured veterans chose to enroll in VA health care to obtain qualifying coverage and avoid individual mandate penalties. Other uninsured low-income veterans (including some who were previously enrolled to receive VA health care or expected to use VA health care in the future) qualified for subsidies to purchase coverage through insurance marketplaces or lived in states that opted to expand Medicaid, which led them to receive some or all of their treatment outside of the VA. Given the new administration’s continued intent to repeal or weaken the ACA, it is imperative to understand the impact that these steps could have on veterans’ health. In 2017, NYHealth awarded RAND Corporation a grant to conduct a study on how a repeal of the ACA would impact veterans, the VA, and federal funding for veterans’ health.

Outcomes and Lessons Learned

  • Created a data set from three large federal surveys to estimate how veterans’ insurance coverage and use of VA health care has changed since implementation of the ACA;
  • Produced a research brief, “Veterans’ Health Insurance Coverage Under the Affordable Care Act and Implication of Repeal for the Department of Veterans Affairs,” in which RAND:
    • Estimated the potential impact of ACA repeal on veterans’ out-of-pocket health care spending and demand for care provided by the VA health system;
    • Used data from the American Community Survey, the National Health Interview Survey, and the Medical Expenditure Panel Survey to determine how many veterans are covered through the ACA’s insurance marketplaces or through ACA-related Medicaid expansion;
    • Identified how out-of-pocket spending and utilization of VA health care have changed for veterans since the ACA was implemented;
    • Estimated how many veterans are likely to lose coverage if certain provisions of the ACA are eliminated; and
    • Analyzed how a repeal of the ACA would affect veterans’ use of and reliance on the VA for health care.
  • Disseminated findings by providing briefings to policymakers:
    • Congressional staffers on the Veterans Affairs and Health committees;
    • The VA Deputy Under Secretary for Health;
    • The majority and minority staff of the Senate VA Committee; and
    • The majority and minority staff of the House VA Committee.

In light of the national attention focused on health reform in 2017, this project examined the effects of federal health reform on a unique population that is typically not associated with the ACA—veterans. This project was particularly unique because it examined intersecting interest areas for the Foundation, including health reform, health coverage, and veterans’ health

Following the release of the report, NYHealth hosted a public discussion, “A Conversation About Veterans’ Health Care Coverage and Access,” to disseminate the findings widely. The report was the focus of articles published in Stars and Stripes, Military Times, Huffington Post, and CNBC.

Based on RAND’s report, NYHealth’s policy and research department conducted its own data analysis and produced a publication focused on the New York-specific impacts of the ACA and ACA repeal on veterans’ health care.

Co-Funding and Additional Funds Leveraged: NYHealth co-funded this project with the Robert Wood Johnson Foundation, which provided $125,000.