Almost half a million veterans gained health care coverage during the first two years of the Affordable Care Act, a report finds.

In the years leading up to the implementation of the ACA’s major coverage provisions, from 2010 to 2013, nearly 1 million of the nation’s approximately 22 million veterans didn’t have health insurance. Almost half of all veterans are enrolled in the VA health system; others get health care through employers or Medicare. But some don’t quality for those options, and others don’t know that they have them.

Two years after the ACA’s implementation, 429,000 veterans under the age of 65 gained coverage, which is a 40 percent drop in vets without insurance from 2013 to 2015. The vets were covered for the most part through Medicaid expansion, privately purchased plans and marketplace coverage, according to the report.

The number of insured veterans rose across demographics like age, gender, race and education level. “The gains in coverage were really broad,” says Jennifer Haley, a research associate at the Urban Institute, a research group based in Washington, D.C., who was an author on the report.

Veterans with the lowest incomes saw the greatest increase in coverage, especially in states that adopted Medicaid expansion. Vets with incomes up to 138 percent of the federal poverty level, or $16,394 a year for an individual, became eligible for Medicaid in expansion states, the report notes.

In 2015, just 4.8 percent of veterans were uninsured in states that participated in Medicaid expansion, compared to 7.1 percent in states that did not.

One in 5 uninsured vets live in states that did not expand Medicaid and would have been eligible for coverage had their state chosen to expand the program, the report found. Haley says these are key data points when considering changes to policy.

“If states would adopt the expansion, more vets would qualify for publicly supported coverage,” she says. Currently, 31 states and the District of Columbia have expanded Medicaid programs, including California, New York, Pennsylvania and Illinois. Another 19 states, including Florida and Texas, have not expanded access to the program.

Veterans weren’t the only ones to benefit from expanded insurance access. Their family members had access to more coverage, too, and by a similar margin.

The overall rate of uninsurance among relatives sank from 9.2 percent in 2013 to 4.5 percent in 2015. For children, the rates fell from 4.5 to 2.9 percent. Overall, 730,000 fewer vets and their family members were lacking health insurance from 2013 to 2015.

The report, published by the Urban Institute, used data from the American Community Survey, which is performed annually by the U.S. Census Bureau. It surveys around 100,000 veterans and 100,000 family members of veterans. The report also considered data from the National Health Interview Survey which is conducted by the Centers for Disease Control and Prevention’s National Center for Health Statistics.

A repeal of the ACA or a rollback of Medicaid could negate these coverage increases and leave more vets without health insurance coverage, the authors note in their report. The VA health system continues to struggle with delays in delivery of services to veterans.

On Wednesday, President Donald Trump signed a law extending the Veterans Choice program, which allows some vets get health care from private providers paid for by the VA and was created to help improve access to timely care.

The $10 billion program has been riddled with problems, as Montana Public Radio’s Eric Whitney reports, including long waits, a confusing, complicated system and delayed payments to providers.

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