purposes and determination of copays during the time period of our study. For all
enrollees, routine care appointments were provided on a first-come first-served
basis regardless of group.5
The VA restructuring affected the availability of health care for all
veterans. For those not previously eligible, the policy introduced a form of non-
employer-provided health insurance. For the previously-eligible (i.e., low-income
or disabled), it represented an increase in the scope of health care and health
insurance, similar to what is available in the private sector. Therefore, this change
provides an exogenous introduction of an outside health insurance option for all
U.S. veterans but not for non-veterans. In order to estimate the spillover effect
from publicly provided health insurance on spousal labor supply choices we
compare the labor supply outcomes of wives of veterans to those of non-veterans
before and after the change.
Previous research indicates that veterans used this health insurance to
leave full-time employment. Between 35 and 70 percent of new VA health care
users are individuals who drop private health insurance plans, potentially because
they are leaving full-time work (Boyle 2009). In response to the policy change,
such as outpatient surgery, audiology and optometry and so on. Preventive care, including flu
shots, hepatitis C screenings, radiology services, electrocardiograms, and so on, was free.
(Department of Veterans Affairs, 2002a)
5 The priority groups did not receive differential access to care during the years of our study.
However, in 2003, budget pressures caused the VA to deny care to the lowest-priority group -
non-disabled non-poor veterans not previously enrolled in the system).