Effects of State-Level Individual Mandate on Veterans' Access to Health Care in the United States

Following the repeal of the federal individual health insurance mandate, five states and D.C. adopted their own state-level individual mandates to counteract the potential negative consequences of the repeal. This study examines the actual changes in veterans' enrollments in private and Veterans Affairs (VA) insurance following the 2019 repeal. By analyzing data from 65,297 non-elderly veterans aged 18 to 64 in the U.S. between 2019 and 2021, we found that state-level individual mandates have positive effects on veterans' enrollments in private and VA insurance, but the effects vary depending on individual income levels. The state-level individual mandate successfully serves as a substitute for the federal mandate. The results imply that veterans in states without individual mandate policies are more likely to worry about health insurance premiums and medical bills, limiting access to health care and potentially worsening health outcomes. Thus, the Veterans Health Administration should endeavor to encourage more state governments to adopt individual mandate policies.