Context/Objective: Provisions of the Affordable Care Act (ACA) potentially increase insurance options for Veterans with disabilities. We examined Veterans with spinal cord injuries and disorders (SCI/D) to assess whether the ACA was associated with changes in healthcare utilization from Department of Veterans Affairs (VA) healthcare facilities.

Design: Using national VA data, we investigated impacts on VA healthcare utilization pre- (2012/13) and post-ACA (2014/15) implementation with negative binomial regression models.

Setting: VA healthcare facilities.

Participants: 8,591 VA users with SCI/D. Veterans with acute myelitis, Guillain-Barré syndrome, multiple sclerosis, or amyotrophic lateral sclerosis were excluded as were patients who died during the study period.

Interventions: We assessed VA healthcare utilization before and after ACA implementation.

Outcome Measures: Total numbers of VA visits for SCI/D care, diagnostic care, primary care, specialty care, and mental health care, and VA admissions.

Results: The number of VA admissions was 7% higher in the post than pre-ACA implementation period (P < 0.01). The number of VA visits post-implementation increased for SCI/D care (8%; P < 0.01) and specialty care (12%; P < 0.001). Conversely, the number of mental health visits was 17% lower in the post-ACA period (P < 0.001). Veterans with SCI/D who live <5 miles from their nearest VA facility received VA care more frequently than those ≥40 miles from VA (P < 0.001).

Conclusion: Counter to expectations, results suggest that Veterans with SCI/D sought more frequent VA care after ACA implementation, indicating Veterans with SCI/D continue to utilize the lifelong, comprehensive care provided at VA.

背景/目标：平价医疗法案 (ACA) 的规定可能会增加残疾退伍军人的保险选择。我们检查了患有脊髓损伤和疾病 (SCI/D) 的退伍军人，以评估 ACA 是否与退伍军人事务部 (VA) 医疗机构的医疗保健利用变化有关。

设计：使用国家 VA 数据，我们使用负二项式回归模型调查了对 VA 医疗保健利用前（2012/13）和后 ACA（2014/15）实施的影响。

设置： VA 医疗机构。

参与者： 8,591 名 SCI/D 的 VA 用户。患有急性脊髓炎、格林-巴利综合征、多发性硬化症或肌萎缩侧索硬化症的退伍军人被排除在外，研究期间死亡的患者也被排除在外。

干预措施：我们评估了 ACA 实施前后的 VA 医疗保健利用率。

结果测量： SCI/D 护理、诊断护理、初级护理、专科护理和心理健康护理以及 VA 入院的 VA 就诊总数。

结果：与 ACA 实施前相比，后期的 VA 入院人数增加了 7%（P < 0.01）。实施后 SCI/D 护理（8%；P < 0.01）和专科护理（12%；P < 0.001）的 VA 就诊次数增加。相反，在 ACA 之后的时期，心理健康就诊的次数减少了 17%（P < 0.001）。居住在离最近的退伍军人事务部<5 英里的 SCI/D 退伍军人比离退伍军人事务部≥40 英里的退伍军人更频繁地接受退伍军人护理（P < 0.001）。

结论：与预期相反，结果表明 SCI/D 退伍军人在 ACA 实施后寻求更频繁的 VA 护理，表明 SCI/D 退伍军人继续利用 VA 提供的终身全面护理。