Abstract
Introduction
The Veterans Health Administration (VA) provides low- to no-cost care to enrolled
Veterans with low incomes. This study assessed associations between VA coverage and
medical financial hardship (MFH) among a nationally representative sample of United
States Veterans with low incomes.
Methods
Using pooled 2015–2018 National Health Interview Survey (NHIS) data, Veterans aged
≥18 years with incomes <200% the Federal Poverty Level were identified (crude N=2,468,
weighted N=3,872,252). Four types of MFH were assessed: objective MFH, and subjective
material, psychological, and behavioral MFH. To examine associations between VA coverage
and MFH, survey-weighted proportions of Veterans with MFH stratified by VA coverage
status were calculated and adjusted probabilities of MFH that accounted for Veteran
characteristics, year fixed effects, and NHIS sampling design were estimated. Analyses
were conducted from August through December, 2022.
Results
Overall, 34.5% of Veterans with low incomes had VA coverage. Among Veterans without
VA coverage, 38.7% had Medicare, 18.2% Medicaid, 16.5% private, 13.5% other public,
and 13.1% were uninsured. In adjusted analyses, compared with Veterans with Medicare
and no VA coverage, Veterans with VA coverage had lower probabilities of objective
(–8.13 percentage-points [pp], p=0.008), subjective material (–6.55 pp, p=0.034),
subjective psychological (–10.33 pp, p=0.003), and subjective behavioral (–6.72 pp,
p=0.031) MFH.
Conclusions
VA coverage was associated with protection against four types of MFH among Veterans
with low incomes, yet, many are not enrolled. Research is needed to understand reasons
these Veterans lack VA coverage and to identify strategies to address MFH.
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© 2023 Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine.
