Health Insurance Coverage Among Veterans Receiving Care From VA Health Care Facilities

Med Care Res Rev. 2022 Aug;79(4):511-524. doi: 10.1177/10775587211048661. Epub 2021 Oct 8.


Reasons for acquiring insurance outside Department of Veterans Affairs (VA) health care coverage among VA enrollees are incompletely understood. To assess Veterans' decision-making and acquisition of non-VA health care insurance in the Affordable Care Act era, we used mailed questionnaires and semistructured interviews in a stratified random sample of VA enrollees <65 years in the Midwest. Of the 3,666 survey participants, 32.1% reported non-VA insurance. Frequently reported reasons included wanting coverage for emergency situations or family members. Those without non-VA insurance cited unaffordability as the main obstacle. Analysis of the semistructured interview data revealed similar findings. In multivariable logistic regression analyses, characteristics associated with non-VA insurance included higher income (>$50,000 vs. <$10,000, odds ratio [OR] = 5.95, 95% confidence interval [CI]: 3.45-10.3, p < .001). As financial barriers exist for acquisition of non-VA insurance and hence community care, it is critically important that VA enrollees' health care needs are met through VA or community providers financed through VA.

Keywords: Affordable Care Act; health policy; insurance; mixed methods; veterans affairs.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Delivery of Health Care
  • Humans
  • Insurance Coverage*
  • Insurance, Health*
  • Interviews as Topic
  • Midwestern United States
  • Patient Protection and Affordable Care Act
  • Surveys and Questionnaires
  • United States
  • United States Department of Veterans Affairs
  • Veterans Health Services / economics*
  • Veterans*