Armed conflict has been a frequent occurrence throughout US history. During the last century, the United States has fought 8 wars that together span more than 35 years, not counting numerous conflicts that are not officially considered wars. In view of the many health consequences of war, the potential effect of the Affordable Care Act (ACA) on health care for veterans warrants careful consideration.
In 2011, there were 22.2 million veterans of service in the US Armed Forces. Veterans are a highly diverse population but can be grouped into 3 categories from a health insurance perspective. Approximately 37% are enrolled in the Department of Veterans Affairs (VA) health care system in accordance with a congressionally mandated eligibility system based on having a service-connected disability, low income and net worth, or other prescribed circumstances. More than 80% of VA enrollees older than 65 years are also covered by Medicare and about 25% of enrollees are beneficiaries of 2 or more non-VA federal health plans (eg, Medicare, Medicaid, TRICARE, or Indian Health Service). Another 56% of veterans have private health insurance or are covered by a non-VA federal health plan, while 7% have no health insurance. These latter veterans are poor or near poor but have incomes or net worth that exceed the mean test thresholds for VA health care eligibility.1
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