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.
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.
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.
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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