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

Rachael N. Martinez, Bridget M. Smith, Dustin D. French, Timothy P. Hogan, Beverly Gonzalez, Chad M. Osteen, Maya Hatch, Vicki Anderson, Elizabeth Tarlov, Abigail Silva, Barry Goldstein, Kevin T. Stroupe

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish (US)
Pages (from-to)575-584
Number of pages10
JournalJournal of Spinal Cord Medicine
Issue number4
StatePublished - 2022


  • Affordable Care Act
  • Health policy
  • Insurance
  • Spinal cord injuries and disorders (SCI/D)
  • Veterans Affairs

ASJC Scopus subject areas

  • Clinical Neurology


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