About 5% of nonelderly veterans are projected to be uninsured in 2024, according to a new Urban Institute report. This represents about 400,000 individuals. More than half, or 52.3%, of uninsured veterans live in states that haven’t opted to expand Medicaid.

“Many people believe that uninsurance is not a problem for veterans due to the Veterans Health Administration within the Department of Veterans Affairs (VA),” the report stated. “While the VA is an important source of coverage for veterans, eligibility is restricted to certain priority groups, such as those who have service-connected disabilities or who have low incomes. Further, even for those who are eligible, not being enrolled or being too far from VA facilities and clinics can make use of their services infeasible.”

The analysis, published Monday, was conducted with support from the Robert Wood Johnson Foundation, a philanthropic organization focused on health equity. The Urban Institute is a research organization focused on economic and social policy. The researchers relied on a microsimulation model of the healthcare system for the report, as well as the 2021 American Community Survey from the U.S. Census Bureau.

The Affordable Care Act (ACA), which passed in 2010, initially called for nationwide expansion of Medicaid to cover nearly all adults under the age of 65 with incomes up to 138% of the federal poverty level. But a 2012 Supreme Court decision left it up to the individual states to decide. As of now, the 10 states that have not expanded Medicaid are Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin and Wyoming.

About one in 10 uninsured veterans in nonexpansion states would be eligible for Medicaid if the states expanded coverage, the researchers found. This population falls in the “coverage gap,” meaning they make more money than the state allows for them to get Medicaid coverage, but have incomes that are too low to qualify for ACA marketplace subsidies.

“Unfortunately, military service does not provide immunity from the gaps in our coverage system, and hundreds of thousands of veterans are uninsured,” said Katherine Hempstead, senior policy adviser at the Robert Wood Johnson Foundation, in a statement.

Overall, almost half (47%) of nonelderly uninsured veterans will be eligible for Medicaid or subsidies through the ACA Marketplace in 2024.

“Since the VA does not cover all veterans, other sources of subsidized coverage, including Medicaid and Marketplace plans, play an important role in providing coverage to veterans,” the researchers said.

Policy changes to increase enrollment among veterans who are eligible for Medicaid or Marketplace coverage are needed, as well as changes to remove the coverage gap, the researchers added.

There’s a major need to increase coverage for the uninsured veteran population, the report also showed. In 2021, about four in five uninsured veterans had incomes below 400% of the federal poverty level.

Of the nonelderly veterans who will be insured in 2024, 57% will receive coverage through their employer, 22% will be insured by the VA or other military or public coverage, 9.4% will be covered by Medicaid and 5.4% will buy Marketplace coverage with premium tax credits, according to the Urban Institute.

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