A. Taylor Kelley is with the Department of Internal Medicine and the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor; and the VA Ann Arbor Healthcare System, Ann Arbor. Renuka Tipirneni is with the Department of Internal Medicine and the Institute for Healthcare Policy and Innovation, University of Michigan. Helen Levy is with the Institute for Social Research, Institute for Healthcare Policy and Innovation, School of Public Health, and Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor.
Am J Public Health. 2019 Sep;109(9):1233-1235. doi: 10.2105/AJPH.2019.305160. Epub 2019 Jul 18.
To evaluate the effect of the Affordable Care Act (ACA) on US veterans' access to care. We used US Behavioral Risk Factor Surveillance System data to compare measures of veterans' coverage and access to care, including primary care, for 3-year periods before (2011-2013) and after (2015-2017) ACA coverage provisions went into effect. We used difference-in-differences analyses to compare changes in Medicaid expansion states with those in nonexpansion states. Coverage increased and fewer delays in care were reported in both expansion and nonexpansion states after 2014, with larger effects among low socioeconomic status (SES) and poor health subgroups. Coverage increases were significantly larger in expansion states than in nonexpansion states. Reports of cost-related delays, no usual source of care, and no checkup within 12 months generally improved in expansion states relative to nonexpansion states, but improvements were small; changes were mixed among veterans with low SES or poor health. Increases in insurance coverage among nonelderly veterans after ACA coverage expansions did not consistently translate into improved access to care. Additional study is needed to understand persisting challenges in veterans' access to care.
评估平价医疗法案（ACA）对美国退伍军人获得医疗服务的影响。我们使用美国行为风险因素监测系统的数据，在 ACA 覆盖条款生效前（2011-2013 年）和生效后（2015-2017 年）的 3 年期间，比较了退伍军人的覆盖范围和获得医疗服务的指标，包括初级保健。我们使用差异中的差异分析比较了医疗补助扩大州和非扩大州的变化。2014 年后，无论是在扩大州还是非扩大州，医疗保健的覆盖范围都有所增加，报告的医疗延误情况有所减少，其中社会经济地位较低（SES）和健康状况较差的亚组的效果更大。在扩大州，覆盖范围的增加明显大于非扩大州。与非扩大州相比，扩张州报告的与费用相关的延误、无常规医疗来源和 12 个月内无体检的情况通常有所改善，但改善幅度较小；SES 较低或健康状况较差的退伍军人的变化情况则各不相同。ACA 覆盖范围扩大后，非老年退伍军人的保险覆盖范围增加，但并没有始终转化为获得医疗服务的改善。需要进一步研究以了解退伍军人获得医疗服务方面持续存在的挑战。
