The Incidental Economist’s Austin Frakt is pimping a paper he co-wrote on how Medicaid expansion has lowered demand for Veterans’ Administration health care services:
If the ACA’s Medicaid expansion had been implemented in all states, enrollment for VA health coverage, acute inpatient care (days), and outpatient visits would have been 9%, 6%, and 12% lower, respectively. In states that did not expand Medicaid in 2014, VA enrollment, inpatient days, and outpatient visits were, respectively, 10, 6, and 13 percentage points higher than they would have been otherwise. VA medical centers in states that did not expand Medicaid in 2014 are likely to have experienced a higher demand, and commensurately longer wait times.
The VA gives excellent care, but it is not always the most convienently located care. This, I think, explains the story. Before the ACA expansion, a vet who is VA eligible and making under 138% of Federal Poverty Line and did not have employer sponsored coverage had the choice to go naked or get VA care. That VA care might be half an hour or an hour from their house. With Medicaid expansion, that same individual has more choices closer to home in most cases. Medicaid expansion is attractive as the next best alternative to it is a 30 minute drive or an hour bus ride to the VA instead of nothing.
Medicaid expansion, as well as the Exchanges with subsidies should also be a notable driver on the number of people who apply for and are later granted Social Security disability. People on Social Security disability qualify for Medicare after two years on disability. There is a good evidence that Social Security disability applications and grants go up when the labor market sucks and goes down when the labor market is good for workers. Part of that cyclical nature can be explained by the marginally attached worker who is in their mid or late 50s who has significant health conditions. That person was completely uninsurable if they were neither employed nor on Social Security disability.
Now people who have something wrong with them are insurable by either Medicaid expansion or the subsidized Exchanges. The cost of staying in the labor market is way lower and disability payments that are slightly above poverty level aren’t too attractive as medical care is no longer restricted to accepting those payments.
Anything in the US healthcare finance and delivery system has seventeen seperate threads tying it to other major parts. Austin does a nice job of outlining one of those connections.
HinTN
Disproving, yet again, the theory that moochers and takers constitute the whole universe outside the Republican orbit. Well done, sir.
walt
The GOP has been very busy in its own “wonkosphere” damning VA care as expensive and substandard. It is neither. But it’s a debating point that is now treated as received wisdom in Dogpatch. Or better yet, go to any VA hospital waiting room and ask the average vet if he’s liberal or conservative. You might think people are liberal in their own lives and conservative when it comes to the lives of others. Welcome to America.
ellennellee
richard, interested to hear your thoughts on the deal pelosi and tangerine man are crafting. not that the final details are available, but it makes me nervous these days when dems agree to anything the gop offers.
Richard Mayhew
@ellennellee: I’ll need more details to have an opinion, and a lot more details/time to have an informed opinion — is this the CHIP extension, Medicare SGR repeal deal?
MomSense
Richard I foolishly listened to part of the Diane Rehm show the other day and they were discussing taxation, health care, and general economic news. I recognized Jared Bernstein’s voice and he did a good job but the conservative guest was just spouting ObamaCare as the reason for every bad thing that has ever happened to anyone. I was so wishing you could have called in to that show.
ObamaCare, labor unions, and regulations (the axis of evil!) are responsible for stagnant wages and underemployment. Jerb creators want nothing more than to hire people full time but don’t because of the tyranny of having to offer them health insurance.
RaflW
One quick comment – I’m sure you meant pimping in a mild or even funny way, but i was prepared for the study to be crap. Then you detail why it’s useful, and I got confusicated.
Maybe that’s me, but I’d consider a synonym.
Other than that – many thanks. Yes it does seem that one of the (many) under-appreciated aspects of ACA is that it should be helping some workers to stay in the workforce and delay claiming disability. I would not have thought of the reductions in VA demand.
I also didn’t know the VA was under any specific legislative attack form the GOP (though I’m not at all surprised). Those f#kers will push and push and push to have another hot war to shove lower-middle class people through the volunteer military meat grinder, but then they’ll screw them over* daily after their service to country is over. Its vile and inhumane. Which seems to be the GOP slogan.
gelfling545
@ellennellee: Don’t worry. The right wingers will stick in some provision about every sperm being sacred or something & kill the deal.
RaflW
*I am having a terrible time with my google-fu this morning. Just a day or two ago I read an article on how military vets and their families are getting royally screwed in credit/loan disputes because while the vets are supposed to have protection from creditors while on deployment, all their credit agreements require binding arbitration which is outside the courts so the federal law protecting vets is moot.
An attempt to revise the law to address this was pounced on by the banking lobby and killed in Congress.
Now I cannot find the damn article. Google can be great, but I keep getting stories that use the word veteran in all sorts of ways like “veteran teachers in dispute with…” Argh!
Anyone else read the article and remember who published it?
gelfling545
@RaflW: I read similar, I think in the NY Times.
TerryC
When I retired last fall I signed up with the VA. The initial signup took 27 minutes, face to face, and they hadn’t expected me ahead of time. I’ve had two colonoscopies, a number of exams, removal of a basal cell carcinoma from my ear, and a number of other things done. All top notch, fast, and with very nice people throughout the process.
beth
@RaflW: There was a thread on it here: https://balloon-juice.com/2015/03/17/marg-bar-banksters-edition-%E2%88%9E/
Sherparick
There was a story on NPR last week about Vets catching a bus in Crown Point, Indiana, to get tests at the VA hospital in Chicago. With traffic, it turns into an all day experience. http://www.npr.org/2015/03/11/392085033/veterans-choice-act-fails-to-ease-travel-burdens-for-vets-in-need-of-care. So expense of time and stress of travel may be encouraging VETS to use ACA and Medicare when they qualify.
JoyfulA
Do veterans who acquired a disability in service get automatic VA benefits?
I was under the impression that all vets were entitled to VA medical, but this article shows I’m wrong. My father has a 10% disability (became permanently deaf in one ear, had painful nerve damage in neck and shoulder for 2 years until supposedly a chiropractor cured it), and although he never took the disability income or general VA medical services (which were then 2 hours away and now about an hour, not 30 minutes), he did go to VA once he began to develop skin cancer. He said the Navy caused the skin cancer by putting him on a ship’s deck all day for 3 years, and the Navy should cure what they caused.
So I’m mistaken that all vets are entitled to VA medical regardless of income. It’s just all vets with service-related injuries. Is that right?
Richard Mayhew
@JoyfulA: It’s complicated and not something I know much about. The following link would be a good spot to start:
http://www.va.gov/healthbenefits/apply/veterans.asp
ThresherK
@Sherparick: Seriously, veterans had to do that?
I thought this was something done only to fetus-carriers. (I don’t even know if I’m kidding anymore.)
pseudonymous in nc
There are a lot of motels near our VA hospital. People will come in from the sticks for a week at a time.
The VA’s been trying to set up local outposts for certain stuff — especially mental health, where there are fewer capital costs and most of the expense comes from paying staff — and that does fill gaps, but there are limits to what you can provide in a geographically large country, just as county hospitals need to pass on certain patients to the local megahealthiplex.
jake the antisoshul soshulist
I had a conversation with an “interesting” vet who told me Army doctor had talked him out of taking disability. He claimed to have spent the last 30+ years fighting the VA to get his benefits.
David in NY
On another health-care related point, once again turns out that although people are divided on Obamacare good/evil, when they’re asked what should be done about it, they want it fixed so people get coverage. Whocoodanode?
http://www.nytimes.com/2015/03/20/us/poll-on-health-care-law-shows-increased-support.html?hp&action=click&pgtype=Homepage&module=second-column-region®ion=top-news&WT.nav=top-news
jim
I’m a veteran who is age qualified for medicare. I’m also lucky enough to live in a mid sized town which has a VA clinic. The care I’ve gotten from VA is excellent and the VA is my provider of choice even though I’m fully insured for Medicare services. If I were not insured by Medicare and I had to drive a hundred miles to a VA clinic, I’m sure I would also resort to Medicaid.