Abstract
Context/Objective: Provisions of the Affordable Care Act (ACA) potentially increase insurance options for Veterans with disabilities. We examined Veterans with spinal cord injuries and disorders (SCI/D) to assess whether the ACA was associated with changes in healthcare utilization from Department of Veterans Affairs (VA) healthcare facilities.Design: Using national VA data, we investigated impacts on VA healthcare utilization pre- (2012/13) and post-ACA (2014/15) implementation with negative binomial regression models.Setting: VA healthcare facilities.Participants: 8,591 VA users with SCI/D. Veterans with acute myelitis, Guillain-Barré syndrome, multiple sclerosis, or amyotrophic lateral sclerosis were excluded as were patients who died during the study period.Interventions: We assessed VA healthcare utilization before and after ACA implementation.Outcome Measures: Total numbers of VA visits for SCI/D care, diagnostic care, primary care, specialty care, and mental health care, and VA admissions.Results: The number of VA admissions was 7% higher in the post than pre-ACA implementation period (P < 0.01). the number of va visits post-implementation increased for sci d care (8%; p >< 0.01) and specialty care (12%; p >< 0.001). conversely, the number of mental health visits was 17% lower in the post-aca period (p >< 0.001). veterans with sci d who live><5 miles from their nearest va facility received va care more frequently than those ≥40 miles from va (p >< 0.001).conclusion: counter to expectations, results suggest that veterans with sci d sought more frequent va care after aca implementation, indicating veterans with sci d continue to utilize the lifelong, comprehensive care provided at va.>
