A new analysis by the Center for American Progress finds that 441,300 veterans would lose Medicaid coverage by 2026 under the plan of President Donald Trump and House Republicans to repeal and replace the Affordable Care Act (ACA). The Senate proposal, crafted behind closed doors, contains even larger Medicaid cuts in the long term than the House plan—cuts that would ultimately result in more veterans losing Medicaid coverage. Moreover, like the House bill, the Senate plan allows states to make changes to essential health benefits, which would reduce current protections for veterans with pre-existing conditions—including service-connected disabilities such as spinal cord injuries, amputations, and post-traumatic stress disorder—and lead to steep increases in medical costs, harming American veterans and their families.
Contrary to common misperceptions, the majority of the nation’s 20 million veterans do not get their health care coverage from the U.S. Department of Veterans Affairs but instead depend on other types of insurance. This includes Medicaid, which currently covers nearly 1.8 million American veterans.
The cuts not only break President Trump’s pledge to support veterans, they also disproportionately harm voters in the areas that most strongly supported him. New CAP analysis reveals that in the counties Trump won in the 2016 presidential election, 10 percent of adults are veterans—45 percent more than the share who are veterans in counties Trump lost.
The table below shows a state-by-state breakdown of the estimated number of veterans who would lose Medicaid coverage by 2026 under the cuts proposed in House Republicans’ American Health Care Act (AHCA). (see Methodology)
Authors’ calculations of state-level estimates of Medicaid coverage loss among veterans are based on estimates from a May 2017 CAP column by Emily Gee regarding overall state-level health insurance losses under the AHCA. We used state-level data on veterans’ Medicaid enrollment in 2015 from the American Community Survey (ACS) 2015 1-year estimates, accessed through the Integrated Public Use Microdata Series, and projected what veterans’ Medicaid enrollment would be in 2026 under the ACA by assuming that the number of veterans enrolled in Medicaid will change at the same rate as the Department of Veterans Affairs forecast of the total number of veterans in each state. We then assumed that the share of veterans losing Medicaid coverage under the AHCA by 2026 will be the same as the share of all adults—which, for the purposes of Medicaid, includes individuals aged 19 and older—losing coverage by 2026. To compute the reduction in Medicaid coverage among adults in 2026, we first scaled up states’ 2015 adult Medicaid enrollment from ACS 2015 1-year estimates according to total projected Medicaid enrollment among adults in 2026 given in the nonpartisan Congressional Budget Office’s (CBO) March 2016 budget projections, which the CBO used in its score of the AHCA. We used estimated state-level coverage losses among all adults aged 19 and older from the Gee column to compute the percentage by which Medicaid coverage will decline by 2026. Finally, we applied these percentage coverage losses to our state-level projection of 2026 Medicaid enrollment among veterans.
Note that this analysis assumes that the share of veterans enrolled in Medicaid in each state remains constant over time, which produces a conservative estimate for two reasons. First, rates of disability for veterans have increased since 2001, and second, the CBO projects that if the ACA is not repealed, additional states will expand Medicaid, extending Medicaid coverage to an additional 5 million people, some of whom would likely be veterans.
The analysis of Trump counties where Trump won the vote combines demographic and income data from the 2015 ACS 5-year estimates with 2016 voting data from the Atlas of U.S. Presidential Elections, which tracks election outcomes in all counties except those in Alaska and a handful of other counties around the country.
Rachel West is an associate director for the Poverty to Prosperity Program at the Center for American Progress. Katherine Gallagher Robbins is the director of family policy for the Poverty to Prosperity Program. Rejane Frederick is an associate director for the Poverty to Prosperity Program.