Dual Insurance Coverage Is Common Among VA Enrollees
BACKGROUND:
VA healthcare spending has grown in the past decade, in part due to legislative changes that expanded Veterans’ access to care that is purchased by VA and provided at non-VA institutions. To inform future legislation on increasing access to VA care, it is essential to examine how insurance coverage for Veterans has changed over time. This study sought to investigate changes in Veterans’ health insurance coverage and insurance sources from 2010 to 2021 by analyzing data from three national surveys, as well as a survey of VA enrollees. Participants included 3.6 million respondents who reported having served in the military and also reported on health insurance enrollment. The main outcome measures were self-reported health insurance coverage, reliance on VA, and self-reported health.
FINDINGS:
- More than 90% of Veterans reported having health insurance coverage from any source. Of those enrolled in VA, more than 75% had another source of coverage.
- In 2010, 94% of all Veterans and 94% of those under age 65 reported having health insurance coverage. By 2020, 97% of all Veterans and 95% of Veterans under age 65 reported having health insurance coverage.
- Approximately one-third of Veterans reported being enrolled in VA, with more than 75% having dual insurance coverage. Among those Veterans, Medicare and private insurance were the most common second insurance sources.
- Veterans with higher VA reliance reported lower health status and lower income. Those in poor health were approximately 3 times more likely to enroll in VA than those in excellent health.
- Veterans without insurance tended to be unemployed and younger.
IMPLICATIONS:
- Future legislative efforts to improve access to care will need to target specific populations and recognize the high rates of dual coverage among Veterans in order to avoid potential unintended consequences such as Veterans shifting their insurance payer (e.g., from Medicare to VA).
LIMITATIONS:
- Variation within surveys over time and across surveys limited researchers’ ability to pull detailed information to help elucidate some of the broader changes in insurance coverage.
- Analyses of survey data introduce potential biases due to non-response, or uncertainty from small samples.
- The researchers did not conduct any statistical tests; no attempt was made to draw causal connections between policies and population trends.
AUTHOR/FUNDING INFORMATION:
This study was funded by HSR (IIR 19-421). All authors except Dr. Aouad are with HSR’s Health Economics Resource Center (HERC). Dr. Wagner is supported by an HSR Research Career Scientist Award.
Wagner TH, Schmidt A, Belli F, Aouad M, Gehlert E, Desai M, Graham L, Rose L. Health Insurance Enrollment Among U.S. Veterans, 2010–2021. JAMA Network Open. August 26, 2024; 7(8):e2430205.
