Table 2.
Association Between ACA Implementation and Changes in Likelihood of Catastrophic Health Expenditures Among US Veterans, by Age, Income, and Primary Payer
| Median family income pre-ACA | Likelihood of CHE pre-ACA |
Likelihood of CHE post-ACA |
Adjusted change in likelihood, pp | 95% CI | |
|---|---|---|---|---|---|
| Veterans aged 18–64 | $66,406 | 5.4% | 3.9% | −1.4* | −2.6, −0.2 |
| By income tercile | |||||
| Low | $28,246 | 13.5% | 10.1% | −3.7* | −6.6, −0.7 |
| Middle | $64,293 | 1.8% | 1.4% | −0.4 | −1.4, +0.7 |
| High | $120,959 | 1.1% | 0.3% | −0.7 | −1.4, +0.0 |
| By primary payer | |||||
| VHA | $52,314 | 5.6% | 5.0% | −0.3 | −3.3, +2.8 |
| Non-VHA | $82,522 | 4.7% | 2.7% | −1.8** | −3.0, −0.6 |
| Uninsured | $37,535 | 8.7% | 8.2% | −0.2 | −4.2, +3.9 |
| By primary payer in low-income tercile | |||||
| VHA | $23,974 | 10.0% | 9.6% | −1.2 | −6.6, +4.1 |
| Non-VHA | $32,299 | 16.3% | 9.3% | −6.5** | −10.5, −2.5 |
| Uninsured | $22,899 | 13.4% | 11.0% | −2.3 | −7.8, +3.2 |
| Veterans aged 65+ | $52,323 | 13.0% | 12.5% | −0.3 | −2.5, +1.8 |
| By income tercile | |||||
| Low | $22,336 | 28.3% | 26.0% | −1.0 | −6.1, +4.0 |
| Middle | $51,492 | 8.3% | 8.6% | +0.3 | −2.8, +3.5 |
| High | $110,476 | 2.7% | 3.0% | +0.2 | −1.6, +2.0 |
| By primary payer | |||||
| VHA | $38,818 | 13.1% | 6.6% | −6.0* | −10.7, −1.2 |
| Non-VHA | $56,015 | 13.3% | 13.7% | +0.5 | −1.9, +3.0 |
| By primary payer in low-income tercile | |||||
| VHA | $22,096 | 22.7% | 12.2% | −9.5* | −18.2, −0.9 |
| Non-VHA | $22,482 | 30.1% | 29.7% | +0.7 | −5.0, +6.4 |
*p<0.05, **p<0.01. pp = percentage points, CHE = catastrophic health expenditures, VHA = Veterans Health Administration. Non-VHA includes Medicare, Medicaid, private insurance, and Tricare. Both VHA and non-VHA refer to individuals with year-round insurance coverage. Uninsured not shown for veterans aged 65+ due to small cell sizes