The Individual Health Insurance Mandate and Veterans Health Coverage

• Date: 01 April 2021
• Author: Dongjin Oh,Frances Stokes Berry
• DOI: 10.1177/0095327X19878874
• Published date: 01 April 2021
• Subject Matter: Articles

Article

The Individual Health

Insurance Mandate

and Veterans

Health Coverage

Dongjin Oh

1

and Frances Stokes Berry

1

Abstract

In December 2017, Congress repealed the individual insurance mandate penalty.

Given the poor health status of veterans, their higher demands for health insur-

ance, and the substantial number of uninsured veterans, the repeal of the individual

mandate should have a significant impact on the veterans. This article investigates

how the repeal of the individual mandate effective in January 2019 is likely to affect

the number of uninsured veterans and their enrollments in Veterans Affairs (VA)

insurance. By analyzing 52,692 nonelderly veterans in Florida and California from

2008 to 2017, the findings suggest that the repeal will lead to a considerable

increase in the number of uninsured veterans. Veterans who are unemployed,

poor, and suffering disabilities are more likely to sign up for the VA insurance than

better-off veterans. Thus, one of the important functions of veteran health care is

to serve as a social safety net for vulnerable veterans. Thus, the Veterans Health

Administration should establish a policy to minimize the expected negative

repercussions of the repeal.

Keywords

veterans, individual mandate, public policy, health insurance, health care

1

Askew School of Public Administration and Policy, Florida State University, Tallahassee, FL, USA

Corresponding Author:

Dongjin Oh, Askew School of Public Administration and Policy, Florida State University, Tallahassee, FL

32306, USA.

Email: do16d@my.fsu.edu

Armed Forces & Society

2021, Vol. 47(2) 248-275

ªThe Author(s) 2019

Article reuse guidelines:

sagepub.com/journals-permissions

DOI: 10.1177/0095327X19878874

journals.sagepub.com/home/afs

In 2016, there were an estimated 18.5 million veterans in the United States. Of those,

510,000 (5.5%) of nonelderly veterans between the ages of 19 and 64 years reported

that they had no health insurance coverage (U.S. Census Bureau, 2017b). Veterans

who generally served in the military for 2 years or more and who did not receive a

dishonorable discharge can use Veterans Affairs (VA) medical facilities regardless

of whether they hold health insurance coverage (U.S. Department of VA, 2019a). A

veteran without health insurance is more likely to use VA medical facilities than a

veteran with health insurance (Hisnanick & Gujral, 1996). Poor and less educated

veterans tend to use VA health-care facilities more often, and a large portion of

veterans using VA health facilities do not have insurance (Nelson, Strakebacu, &

Reiber, 2007).

The expansion of the Affordable Ca re Act (ACA) contr ibuted to a reducti on in

the number of the uninsured veterans through expanding Medicaid eligibility.

1

Also, the ACA made private health insurance more available by subsidizing the

purchase of insurance and by capping of out-of-pocket costs. The ACA has a

provision called the “individual mandate” that requires people living in the United

States to have health insurance that meets minimum standards of coverage and

imposes a tax fine penalty on those who fail to comply with that provision. This

provision was critical to reducing health insurance premiums by requiring that

every individual purchase health insurance regardless of his or her health status

or age. However, in the Tax Cuts and Jobs Act passed in December 2017, Congress

repealed the tax penalty of the individual health insurance mandate. While the

repeal is expected to reduce the federal budget deficit by US$338 billion from

2019 through 2027 (U.S. Congressional Budget Office [CBO], 2017), the repeal

will allow healthy individuals to leave their health insurance coverage group, and

due to the increased risk of financial loss, health insurance companies will likely

require a higher premium for the remaining individuals who still need the

insurance.

The U.S. CBO estimated that the repeal would increase the number of uninsured

by 4 million in 2019 and 13 million in 2027, while the average insurance premium

for the nongroup market

2

would increase by about 10%(U.S. CBO, 2017). Numer-

ous scholars have studied the impact of eliminating the individual health insurance

mandate on premiums in individual insurance markets and on the number of unin-

sured individuals (Eibner & Price, 2012; Eibner & Sa ltzman, 2015; Hackmann,

Kolstad, & Kowalski, 2015; Sheils & Haught, 2011). However, there has been little

research focusing on the expected repercussions on veteran health coverage. In this

article, I examine the impacts of the ACA on veteran health benefits and discuss the

expected repercussions of its repeal on the number of uninsured veterans and VA

insurance enrollments. I analyzed 52,692 nonelderly veterans from 2008 to 2017 in

California (CA) and Florida (FL). Also, I analyzed 97,521 nonelderly nonveterans in

the two states to compare the effect of the individual mandate between veterans and

nonveterans.

Oh and Berry 249