The Individual Health Insurance Mandate and Veterans Health Coverage

2019 ◽  
pp. 0095327X1987887 ◽  
Author(s):  
Dongjin Oh ◽  
Frances Stokes Berry
Keyword(s):  
Health Insurance ◽  
Safety Net ◽  
Veterans Health ◽  
Health Coverage ◽  
Health Administration ◽  
Social Safety Net ◽  
Individual Mandate ◽  
Insurance Mandate ◽  
The Individual ◽  
Veteran Health Care

In December 2017, Congress repealed the individual insurance mandate penalty. Given the poor health status of veterans, their higher demands for health insurance, and the substantial number of uninsured veterans, the repeal of the individual mandate should have a significant impact on the veterans. This article investigates how the repeal of the individual mandate effective in January 2019 is likely to affect the number of uninsured veterans and their enrollments in Veterans Affairs (VA) insurance. By analyzing 52,692 nonelderly veterans in Florida and California from 2008 to 2017, the findings suggest that the repeal will lead to a considerable increase in the number of uninsured veterans. Veterans who are unemployed, poor, and suffering disabilities are more likely to sign up for the VA insurance than better-off veterans. Thus, one of the important functions of veteran health care is to serve as a social safety net for vulnerable veterans. Thus, the Veterans Health Administration should establish a policy to minimize the expected negative repercussions of the repeal.

America's Neglected Veterans: 1.7 Million Who Served Have No Health Coverage

2005 ◽  
Vol 35 (2) ◽  
pp. 313-323 ◽  
Author(s):  
Steffie Woolhandler ◽  
David U. Himmelstein ◽  
Ronald Distajo ◽  
Karen E. Lasser ◽  
Danny McCormick ◽  
...  
Keyword(s):  
World War Ii ◽  
Health Insurance ◽  
Medical Care ◽  
Insurance Coverage ◽  
Military Veterans ◽  
Health Care Facilities ◽  
Veterans Health ◽  
Health Coverage ◽  
Health Administration ◽  
Vietnam Era

Many U.S. military veterans lack health insurance and are ineligible for care in Veterans Administration health care facilities. Using two recently released national government surveys—the 2004 Current Population Survey and the 2002 National Health Interview Survey—the authors examined how many veterans are uninsured (lacking health insurance coverage and not receiving care from the VA) and whether uninsured veterans have problems in access to care. In 2003, 1.69 million military veterans neither had health insurance nor received ongoing care at Veterans Health Administration (VHA) hospitals or clinics; the number of uninsured veterans increased by 235,159 since 2000. The proportion of nonelderly veterans who were uninsured rose from 9.9 percent in 2000 to 11.9 percent in 2003. An additional 3.90 million members of veterans' households were also uninsured and ineligible for VHA care. Medicare covered virtually all Korean War and World War II veterans, but 681,808 Vietnam-era veterans were uninsured (8.7 percent of the 7.85 million Vietnam-era vets). Among the 8.27 million veterans who served during “other eras” (including the Persian Gulf War), 12.1 percent (999,548) lacked health coverage. A disturbingly high number of veterans reported problems in obtaining needed medical care. By almost any measure, uninsured veterans had as much trouble getting medical care as other uninsured persons. Thus millions of U.S. veterans and their family members are uninsured and face grave difficulties in gaining access to even the most basic medical care.

Religious Exemptions to the PPACA's Health Insurance Mandate

2011 ◽  
Vol 37 (4) ◽  
pp. 624-651 ◽  
Author(s):  
Samuel T. Grover
Keyword(s):  
Health Insurance ◽  
Focal Point ◽  
Circuit Court ◽  
Patient Protection ◽  
Commerce Clause ◽  
Legal Challenges ◽  
Individual Mandate ◽  
Insurance Mandate ◽  
The Individual ◽  
Circuit Courts

Arguably the most controversial change to the U.S. healthcare system written into the Patient Protection and Affordable Care Act (“PPACA” or the “Act”) is what has been colorfully termed the Act’s “individual mandate,” the provision that establishes tax penalties for those who do not maintain health insurance in 2014 and beyond. Though the health insurance mandate does not go into effect until 2014, it has already faced numerous constitutional challenges in district and circuit courts, with entirely inconsistent results. Conflicting decisions regarding the Act’s constitutionality at the circuit court level cry out for Supreme Court review. But while the individual mandate’s validity under either the Commerce Clause or Congress’s taxing power has been the focal point of litigation thus far, another aspect of the individual mandate may undermine the goal of establishing universal, affordable healthcare coverage for all Americans. As currently written, the religious conscience exemption from the PPACA’s individual mandate threatens the efficacy of the Act and potentially exposes it to legal challenges under the Constitution’s Religion Clauses.

scholarly journals The "State of Implementation" Progress Report (SIPREP): A Pilot Demonstration of a Navigation System for Implementation

2020 ◽  
Author(s):  
Edward J Miech ◽  
Angela Larkin ◽  
Julie C Lowery ◽  
Andrew J Butler ◽  
Kristin M Pettey ◽  
...  
Keyword(s):  
Navigation System ◽  
Organizational Context ◽  
Medical Center ◽  
Veterans Health ◽  
Health Administration ◽  
Novel Approach ◽  
Wide Range ◽  
The Individual ◽  
Implementation Progress ◽  
Specific Implementation

Abstract Background: Implementation of new clinical programs across diverse facilities in national healthcare systems like the Veterans Health Administration (VHA) can be extraordinarily complex. Implementation is a dynamic process, influenced heavily by local organizational context and the individual staff at each medical center. It is not always clear in the midst of implementation what issues are most important to whom or how to address them. In recognition of these challenges, implementation researchers within VHA developed a new systemic approach to map the implementation work required at different stages and provide ongoing, detailed and nuanced feedback about implementation progress.Methods: This observational pilot demonstration project details how a novel approach to monitoring implementation progress was applied across two different national VHA initiatives. Stage-specific grids organized the implementation work into columns, rows and cells, identifying specific implementation activities at the site level to be completed along with who was responsible for completing each implementation activity. As implementation advanced, item-level checkboxes were crossed off and cells changed colors, offering a visual representation of implementation progress within and across sites across the various stages of implementation. Results: Applied across two different national initiatives, the SIPREP provided a novel navigation system to guide and inform ongoing implementation within and across facilities. The SIPREP addressed different needs of different audiences, both described and explained how to implement the program, made ample use of visualizations, and revealed both what was happening and not happening within and across sites. The final SIPREP product spanned distinct stages of implementation. Conclusions: The SIPREP made the work of implementation explicit at the facility level (i.e., who does what, and when) and provided a new common way for all stakeholders to monitor implementation progress and to help keep implementation moving forward. This approach could be adapted to a wide range of settings and interventions, and is planned to be integrated into the national deployment of two additional VHA initiatives within the next 12 months.

scholarly journals The “State of Implementation” Progress Report (SIPREP):A Pilot Demonstration of a Navigation System for Implementation

2020 ◽  
Author(s):  
Edward J Miech ◽  
Angela Larkin ◽  
Julie C Lowery ◽  
Andrew J Butler ◽  
Kristin M Pettey ◽  
...  
Keyword(s):  
Navigation System ◽  
Organizational Context ◽  
Medical Center ◽  
Veterans Health ◽  
Health Administration ◽  
Novel Approach ◽  
Wide Range ◽  
The Individual ◽  
Implementation Progress ◽  
Specific Implementation

Abstract Background: Implementation of new clinical programs across diverse facilities in national healthcare systems like the Veterans Health Administration (VHA) can be extraordinarily complex. Implementation is a dynamic process, influenced heavily by local organizational context and the individual staff at each medical center. It is not always clear in the midst of implementation what issues are most important to whom or how to address them. In recognition of these challenges, implementation researchers within VHA developed a new systemic approach to map the implementation work required at different stages and provide ongoing, detailed and nuanced feedback about implementation progress.Methods: This observational pilot demonstration project details how a novel approach to monitoring implementation progress was applied across two different national VHA initiatives. Stage-specific grids organized the implementation work into columns, rows and cells, identifying specific implementation activities at the site level to be completed along with who was responsible for completing each implementation activity. As implementation advanced, item-level checkboxes were crossed off and cells changed colors, offering a visual representation of implementation progress within and across sites across the various stages of implementation. Results: Applied across two different national initiatives, the SIPREP provided a novel navigation system to guide and inform ongoing implementation within and across facilities. The SIPREP addressed different needs of different audiences, both described and explained how to implement the program, made ample use of visualizations, and revealed both what was happening and not happening within and across sites. The final SIPREP product spanned distinct stages of implementation. Conclusions: The SIPREP made the work of implementation explicit at the facility level (i.e., who does what, and when) and provided a new common way for all stakeholders to monitor implementation progress and to help keep implementation moving forward. This approach could be adapted to a wide range of settings and interventions, and is planned to be integrated into the national deployment of two additional VHA initiatives within the next 12 months.

First-line chemotherapy (CT) versus anti-androgen therapy (AT) for patients (pts) with metastatic castration-resistant prostate cancer (mCRPC): Individual patient analysis of the Veterans Health Administration (VHA) dataset.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 156-156 ◽  
Author(s):  
Guru Sonpavde ◽  
Ahong Huang ◽  
Li Wang ◽  
Onur Baser ◽  
Raymond Miao
Keyword(s):  
Prognostic Factors ◽  
Multivariable Analysis ◽  
Specific Antigen ◽  
Veterans Health ◽  
Health Administration ◽  
Castration Resistant Prostate Cancer ◽  
First Line ◽  
Cox Proportional Hazard Models ◽  
The Individual ◽  
The Impact

156 Background: The outcomes of pts receiving first-line CT vs AT for mCRPC are unclear. Using the VHA dataset, we compared outcomes with first-line CT vs AT in pts with mCRPC and assessed the impact of prior androgen deprivation therapy (ADT) duration and known prognostic factors. Methods: Pts with mCRPC initiating first-line AT (abiraterone, enzalutamide) or CT (taxane) from Oct 2012 to Sept 2014 were identified. The impact of AT vs CT on overall survival (OS) and time to discontinuation (TTD) was assessed using Cox proportional hazard models, adjusting for prior ADT duration, known prognostic factors (hemoglobin [Hb], albumin [alb], alkaline phosphatase [ALP], prostate-specific antigen [PSA]), Charlson Comorbidity Index (CCI) and chronic disease score (CDS). Results: Overall, 1445 pts were evaluable; 1108 received AT (abiraterone 996, enzalutamide 112) and 337 received CT (docetaxel). The overall median duration of prior ADT was 464 days. On multivariable analysis, prior ADT duration, CCI, CDS, Hb, Alb, ALP and PSA were associated with OS, but AT vs CT was not (HR: 1.041 [95% CI: 0.853–1.270], p = 0.6943). PSA levels, prior ADT duration, and ALP was associated with TTD, and TTD was shorter for CT vs AT (HR: 2.339 [95% CI: 1.969–2.779], p < 0.0001). Longer prior ADT duration was associated with longer OS (HR: 0.566, p < 0.0001) and TTD (HR: 0.831, p = 0.0363) in the AT cohort, but not in the CT cohort. Treatment-free interval (TFI) (between first- and second-line treatment) was longer for CT vs AT (mean: 53 vs 39 days; p = 0.0303). Conclusions: To our knowledge, this is one of the largest mCRPC datasets analyzed at the individual pt level comparing first-line CT vs AT. OS was not significantly different for first-line CT vs AT after adjusting for key prognostic factors, despite shorter TTD with CT and longer TFI after first-line CT. Prior ADT duration ≤ 464 days was associated with shorter OS and TTD in the AT cohort, but not the CT cohort, suggesting that such pts may benefit from receiving CT over AT. The results are hypothesis-generating and prospective validation is required. Funding: Sanofi Genzyme

Abstract P163: Racial, Gender and Regional Variation in Rates of Cardiovascular Hospitalization Among 9 Million US Veterans

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Nirupama Krishnamurthi ◽  
Mary A Whooley
Keyword(s):  
Geographical Distribution ◽  
Rural Areas ◽  
Population Level ◽  
Healthcare Services ◽  
Veterans Health ◽  
Health Administration ◽  
Health Records ◽  
Race Ethnicity ◽  
The Individual ◽  
Va Hospitals

Introduction: Little is known about population-level trends in rates of cardiovascular hospitalizations among U.S. Veterans. Recent adoption of a centralized Corporate Data Warehouse in the Veterans Health Administration (VHA) provides a new opportunity to evaluate trends in national rates of hospitalization among Veterans. We sought to determine the leading causes of cardiovascular (CV) hospitalization, and to compare national rates of CV hospitalization by age, gender, race, ethnicity, geographical distribution and year, among U.S. Veterans. Methods: We evaluated the electronic health records of all Veterans ≥18 years old that accessed VA healthcare services between January 1 2010 and December 31 2014. Among these 9,066,693 patients, we identified the 5 leading causes of CV hospitalization and compared rates of hospitalization by age, gender, race, ethnicity, geographical distribution and year. Results: The top 5 causes of CV hospitalization in VA hospitals were: chest pain (3.23 per 1,000 Veterans per year), coronary arteriosclerosis in native artery (2.36), congestive heart failure (1.82), atrial fibrillation (1.34) and acute sub-endocardial infarction (0.99). Overall, the rate of Veterans hospitalized for one or more of these CV conditions decreased over time, from 9.9 per 1000 Veterans in 2010 to 8.3 per 1000 Veterans in 2014. The odds of hospitalization due to any of the 5 conditions were higher in men vs. women (OR 1.73, p<0.0001), in urban vs. rural areas (OR 1.15, p<0.0001), and in the Southeast vs. Pacific regions (OR 1.08, p<0.0001). As compared with Whites, odds of CV hospitalization were higher in Blacks (OR 1.34, p<0.0001) but lower in Asians (OR 0.50, p<0.0001). Racial, geographic and temporal differences in rates of hospitalization were also observed for each of the individual CV conditions. Conclusions: Among U.S. Veterans enrolled in the VA healthcare system, there is substantial variation in rates of CV hospitalization by age, gender, race, geographical distribution and year.

What is the actual prevalence of medical bankruptcies?

2016 ◽  
Vol 43 (12) ◽  
pp. 1284-1299 ◽  
Author(s):  
Donald D. Hackney ◽  
Daniel Friesner ◽  
Erica H. Johnson
Keyword(s):  
Ad Hoc ◽  
Safety Net ◽  
Extensive Literature ◽  
Social Safety Net ◽  
Content Type ◽  
The Social ◽  
Health Event ◽  
The Individual ◽  
Medical Bills ◽  
Actual Prevalence

Purpose Medical bankruptcies occur when an individual experiences an acute or chronic health event, and the costs of care exceed the individual’s ability to pay. In such cases, the individual typically files for bankruptcy. There is an extensive literature that estimates the prevalence of medical bankruptcy, but studies either select a population whose medical care is extremely expensive or chooses ad hoc thresholds for medical bankruptcy categorizations. In both cases, the prevalence of medical bankruptcy is biased. The purpose of this paper is to estimate the actual prevalence of medical bankruptcies in a manner that avoids these limitations. Design/methodology/approach Data are randomly drawn from a single US Bankruptcy Court district. Following the literature, an ad hoc threshold of medical debts which places the bankruptcy filer “at risk” for a medical bankruptcy is postulated. Misclassification analyses are used to estimate the likelihood of a medical bankruptcy filing while adjusting for the use of ad hoc thresholds. Findings The naive prevalence of medical bankruptcy is 23.1 percent, but exceeds 50 percent when accounting for misclassification. Many individuals are “ostensibly” medically bankrupt. They are already seriously indebted, and any outside financial shock, including but not limited to medical bills, can push these debtors into insolvency. Originality/value Bankruptcy is an important social safety net. An improved understanding of the types and magnitudes of medical debts which precipitate a bankruptcy filing can lead to policies that improve outcomes for bankruptcy filers and reduce the social costs of bankruptcy.

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