Veterans Mental Health Problems and the Affordable Care Act Essay

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Current status in implementing the affordable care act with regard to veterans' mental health problems

The Affordable Care Act's enactment gave rise to major concerns with regard to greater healthcare expenditure and reduced benefits for the defense population. This has led to the VA (Department of Veteran Affairs), the White House and TRICARE authorities expending efforts towards public education. Veteran Affairs believes the Act (popularly called Obamacare) has no effect on military veterans' entitlement to and accessibility of the mental health services they were already recipients of, and also doesn't affect TRICARE for Life or TRICARE benefits enjoyed by households on behalf of VA. Rather, the department maintained that VA-enrolled individuals require no added insurance coverage. But the Act would provide them a chance to sign up for further insurance plans through the novel healthcare insurance exchanges which were set to open in the year 2014 (Russell & Figley, 2014). Moreover, it stated that veterans who were private insurance beneficiaries may profit from the novel consumer protections laid down by the Act which forbid private insurers against cutting out the insured who get hurt or ill. Lastly, veterans need not be concerned any longer about the lifetime ceilings on the amounts their insurers would cover in the long run.

Most significantly, under the Act, veterans and families who were uninsured and, at present, not entitled to TRICARE or VA mental health services were now entitled to tax credits for buying insurance coverage through the soon-to-open exchanges, thereby offering them accessibility of key mental health services (Russell & Figley, 2014).

Of the roughly 23.8 million veteran citizens of the US, the majority (15.96 million individuals) lack a VA healthcare system enrolment. A large number of these individuals can access reasonably priced, superior-quality healthcare insurance plans by means of state insurance exchanges that offer increased choice and promote competition. They may also be entitled to cost-sharing cutbacks and premium tax credits (Hayley & Kenney, 2012). Thus, improvements to the private healthcare marketplace can aid several million US veterans too. Obamacare claims Veteran Affairs continues to maintain absolute power over its own health system, with the Congress offering a provision which claims the system satisfies the national healthcare coverage standard. Thus, no predictable negative effect seems evident for veteran recipients of VA's mental health services.

Through VA, several million ex-servicemen are able to access health services. However, not all are able to qualify for these facilities and not all avail themselves of them. Backlogs and extended waits have long been a menace for the organization. A survey conducted in the year 2015 on the not-for-profit organization, IAVA (Iraq and Afghanistan Veterans of America), discovered that fifty-eight percent of participants reported to being mentally ill on account of their service in the two countries (Schreiber & McEnany, 2015). Reduced mental healthcare coverage under Medicaid may prove disadvantageous for ex-servicemen, who develop post-traumatic stress disorder (PTSD) and other psychological problems, and are more prone to committing suicide as compared to the mainstream population of America.

How a culture's structure and values influence privilege and power

Armed forces culture supports self-dependence, internal strength, and the capacity of getting over injuries, thus adding significantly to the stigma associated with psychological problems. Commanders are heavily pressurized to set out with troops at their full strength. Units are deployed to war with scare resources in case soldiers aren't ready for deployment (American Public Health Association, 2014). Therefore, commanders are coerced into pushing their subordinates to deploy, despite them lacking complete physical or psychological wellbeing. Such incentive systems play a role in maintaining the armed forces culture's current situation.

Stigma leads to unwillingness to look for and accept assistance, together with a fear of being faced with negative societal repercussions. The aforementioned obstacles to care are recognized as graver than the VA system's innate institutional obstacles. Only four out of ten veterans suffering from psychological ailments avail themselves of mental healthcare facilities; further, only fifty percent of veterans actually seeking out care show up at referral appointments (American Public Health Association, 2014). The above figures may largely be ascribed to stigma. Almost a quarter of former servicemen who have been diagnosed with mental ailments claim they failed to pursue care as their superiors persuaded them against using mental healthcare services.

The stigma linked to psychological ailments and seeking medical aid for them is the most common reason behind individuals refraining from seeking services such as counseling.

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Stigma makes people unlikely to seek help even if this decision has serious repercussions for them. Indeed, at the time of the NFCMH's (New Freedom Commission on Mental Health) launch in April of 2002, the then-President Bush affirmed that stigma associated with mental disorders was the key barrier to citizens enjoying the superior-quality psychological health services they were deserving of. The above finding is in line with the surgeon general's mental health report issued in 1999 (American Public Health Association, 2014). The report stated that the fear of being stigmatized prevented people from accept they were ailing, getting treated, and complying with their treatment regimen, thereby giving rise to unneeded suffering. Both the report and the NFCMH emphasize the significance of acquiring an improved grasp of the part played by stigma in pursuing medical treatment in order to implement efforts for decreasing stigma. Self-stigma is predictive of more negative attitudes towards seeking help and is a mediator in the link between perspective on care-seeking and stigma on the public's part.

Effectiveness of the policy: strengths and weaknesses? Cite specific examples to support your analysis.

Obamacare will extend healthcare insurance to cover poor households via state-based healthcare insurance exchanges and Medicaid. This ought to ensure healthcare insurance availability to uninsured ex-servicemen. The novel coverage alternatives can be accessed by innumerable VA healthcare recipients, enlarging their healthcare alternatives and possibly enhancing care relevance and convenience; however, simultaneously, they serve to fragment care, as well. Care fragmentation is worrying, since it weakens care coordination and continuity, leading to more emergency room visits, hospital admissions, adverse incidents and diagnostic interventions (Bernard, 2016). Veteran Affairs caters to a particularly substantial share of individuals suffering from mental or chronic health issues -- individuals who are particularly susceptible to the unfortunate consequences of fragmented care.

Ex-servicemen with twofold or more healthcare plan qualification typically experience more fragmented healthcare; but, related problematic influences are yet to be properly examined. Some facts indicate veterans who are recipients of care from non-VA as well as VA sources will be more prone to re-admissions to hospitals and to perish in a span of 12 months as compared to those using only VA. However, why such disproportionate mortality occurs is yet to be explained (Bernard, 2016). Medicare/VA dual-eligible former servicemen who have suffered heart attacks and avail themselves of both benefits go through more comprehensive cardiac procedures but fail to gain any survival advantages over those availing themselves of only VA. Once again, the negative impacts of more invasive process use by physicians not part of the VA system remains unexplored.

Increased healthcare alternatives can have a negative influence on certain veterans' quality of care in ways apart from fragmented care. Private practitioners might be ill-equipped to treat veterans' issues. For instance, the Pennsylvanian Reaching Rural Veterans program discovered that private primary care practitioners did not possess awareness of psychological issues like PTSD common among servicemen or of the VA therapeutic resources to deal with these ailments (Bernard, 2016). Further, several researches reveal that VA beneficiaries depict much greater likelihood to receive proposed prevention services, evidence-based therapy and timely diagnoses of cardiovascular ailments, contagious illnesses, cancer and diabetes as compared to non-VA recipients.


i. Lack of need to acquire further coverage

As ex-servicemen's healthcare initiative fulfils legally accepted health standards, VA beneficiaries need not acquire further healthcare coverage. They can, however, obtain further coverage should they so desire. However, this isn't mandated for them under the law.

ii. Expanded economical and enhanced care alternatives

Obamacare encompasses provisions ensuring ex-servicemen enjoy more alternatives to reasonable, superior-quality care. It enables VA healthcare beneficiaries to sign up for insurance plans via healthcare insurance exchanges as well. In case of moderate-income users, once again, the decision regarding moving from VA to a health insurance exchange plan may trigger expenditure-sharing comparisons (Boscarino et al., 2015). Servicemen suffering from non-service-related health problems, who thus pay steep VA co-payments, may find the latter more beneficial.

iii. Enhanced flexibility

Obamacare doesn't call for modifications in the ex-military and existing military healthcare plans; it also, concurrently, guarantees more insurance alternatives for them, besides more consumer protections for deterring private insurers from refusing coverage or setting ceilings on it (Boscarino et al., 2015).

iv. Covering….....

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American Public Health Association. (2014). Removing barriers to mental health services for veterans. Policy statements and advocacy.

Bernard, D. (2016, June). The Affordable Care Act, Expanded Insurance Eligibility and Financial Burdens among Veterans. In 6th Biennial Conference of the American Society of Health Economists. Ashecon.

Boscarino, J. A., Hoffman, S. N., Pitcavage, J. M., & Urosevich, T. G. (2015). Mental Health Disorders and Treatment Seeking Among Veterans in Non-VA Facilities: Results and Implications from the Veterans' Health Study. Military behavioral health, 3(4), 244-254.

Boudiab, L. D., & Kolcaba, K. (2015). Comfort Theory: Unraveling the Complexities of Veterans' Health Care Needs. Advances in Nursing Science, 38(4), 270-278.

Haley, J., & Kenney, G. M. (2012). Uninsured veterans and family members: who are they and where do they live? Washington, DC: Urban Institute.

Kilbourne, A., & Atkins, D. (2015). Evidence-Based Policy Making Balancing Rigor with Real-World Health Care for Veterans and Military Personnel. North Carolina medical journal, 76(5), 339-342.

Kizer, K. W. (2012). Veterans and the Affordable Care Act. Journal of the American Medical Association, 307, 789 -- 790.

Russell, M. C., & Figley, C. R. (2014). Overview of the affordable care act's impact on military and veteran mental health services: nine implications for significant improvements in care. Journal of social work in disability & rehabilitation, 13(1-2), 162-196.

Schreiber, M., & McEnany, G. P. (2015). Stigma, American military personnel and mental health care: Challenges from Iraq and Afghanistan. Journal of Mental Health, 24(1), 54-59.

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