Impact of the Implementation of the Patient Protection and Affordable Care Act on Veterans Health Administration: Study of Utilization, Access and Patient Satisfaction by Veterans 64 Years or Younger
The VHA’s solitary reign of bureaucratic healthcare management ended upon the enactment of the Personal Protection and Affordable Care Act (ACA) March 23, 2010, and subsequent implementation January 1, 2014. With the implementation of ACA in January 1, 2014, more opportunities for healthcare coverage were created for American citizens, and military Veterans. However, it is still predicted that 19 million Americans will remain uninsured after ACA. Included in this number is that 7.7% of Veterans, 1.8 million, will remain uninsured (Tsai & Rosenheck, March 2014). The existence of one universal health care system (UHC), the VHA, at the same time another UHC was implemented, ACA, is the focus of this study. More specifically this study 1) Examines the impact of the convergence of ACA on VHA through the lens of the theoretical framework of Implementation theory 2) Explores utilization and access, and patient satisfaction data on a cohort of military Veterans seeking care at VA Tennessee Valley Health between January 1, 2011 thru December 31, 2016 spanning a 3-year period prior and a 3-year period following the implementation of ACA January 1, 2014 and 3) Considers an expansion of implementation theory by examining the “impact” of one UHC on another. This study analyzed descriptive and qualitative data by analyzing the Survey of Healthcare Experiences of Patients (SHEP), and by conducting a focus group with Post 9/11 Veterans that enrolled for VHA healthcare. SHEP Data reveals differences between PreACA and PostACA Veterans in the areas of utilization and satisfaction but no difference in access. Analysis of Iraq/Afghanistan combat war Veteran focus group participants reveals that the majority, despite dual healthcare coverage, reported primary utilization and access of VA healthcare. The study explores expansion of implementation theory as it considers the “impact” of one public policy upon a pre-existing public policy. This “impact” is revealed in analyzing the awareness, utilization, and satisfaction of Veteran patients of VHA and ACA. VHA’s bottom-up implementation approach appears to have provided a foundation in which Veterans are more engaged in VA healthcare positively due to the involvement of numerous major actors and street level bureaucrats in its implementation phase. ACA’s top-down approach, however, indicates need for improvements in connecting ACA policy with existing VHA policy to further benefit the Veteran population and their families from a “grassroots” and “street level approach.”
Public policy|Public administration|Health care management|Military studies
Tonia L Hardyway,
"Impact of the Implementation of the Patient Protection and Affordable Care Act on Veterans Health Administration: Study of Utilization, Access and Patient Satisfaction by Veterans 64 Years or Younger"
ETD Collection for Tennessee State University.