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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 &lt; 0.01). The number of VA visits post-implementation increased for SCI/D care (8%; P &lt; 0.01) and specialty care (12%; P &lt; 0.001). Conversely, the number of mental health visits was 17% lower in the post-ACA period (P &lt; 0.001). Veterans with SCI/D who live &lt;5 miles from their nearest VA facility received VA care more frequently than those ≥40 miles from VA (P &lt; 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.

Effect of the Affordable Care Act on healthcare utilization for Veterans with spinal cord injuries and disorders