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Low priority veterans could lose their VAHC eligibility

The House Budget Committee, chaired by Rep. Paul Ryan, R-Wis., has told a veterans’ group it is studying a plan to save $6 billion annually in VA health care costs by cancelling enrollment of any veteran who doesn’t have a service-related medical condition and is not poor.

Committee Republicans, searching for ways to curb federal deficits and rein in galloping VA costs, are targeting 1.3 million veterans who claim priority group 7 or 8 status and have access to VA care.

Priority group 8 veterans have no service-connected disabilities and annual incomes, or net worth, that exceed VA means-test thresholds and VA “geographic income” thresholds, which are set by family size.

Priority Group 7 veterans also have no service-connected disabilities and their incomes are above the means-test thresholds. But their incomes or net worth fall below the geographic index.  In other words, because of where they live, in high cost areas, they likely struggle financially.

Joseph Violante, national legislative director for Disabled American Veterans, said he learned of the committee’s interest in narrowing access to VA clinics and hospitals from a DAV member from Wisconsin, chairman Ryan’s home state.

A budget committee staffer reminded Violante that proponents for opening VA health care to all veterans had argued it would be cost neutral because VA would charge  modest co-payments for care.  Also VA would bill veterans’ private health insurance plans.

That 1996 argument was wrong. Co-payments and private insurance plan billings cover only 18 percent of the cost of care for group 7 and 8 veterans. By 2009, the annual net cost to  treat these veterans was $4.4 billion or 11 percent of VA’s annual medical appropriation.

The figures come from the Congressional Budget Office’s annual report to Congress,’“Reducing the Deficit: Spending and Revenue Options.”  Among options it presented this year to  Congress for reducing VA spending is one to close enrollment in VA care for veterans in groups 7 and 8 and to cancel existing enrollments.

CBO said this would save VA $62 billion in the first 10 years, from 2012 to 2021. But the net savings to the government over the same period, CBO said, would be about half that amount. That’s because many of the veterans are old enough or poor enough to use Medicare or Medicaid, which would drive up the cost of those programs.

During the Clinton administration, Congress enacted the Veterans’ Health Care Eligibility Act of 1996. The law directed VA to build clinics across the country. To ensure enough patients, the VA secretary was given authority to expand care eligibility.

The ban on group 7 and 8 veterans was ended by 1999.  Over the next three years their enrollment climbed to 30 percent of total enrollees. By 2003, then-VA Secretary Anthony Principi stopped group 8 enrollments, saying their numbers strained the system for higher priority veterans, including wounded returning from Afghanistan and Iraq.

Violante said DAV members worry that tossing 1.3 million veterans from VA care would leave the system without the “critical mass” of patients needed to provide “a full continuum of care.”

CBO presented pros and cons for cancelling 7 and 8 enrollments.  An advantage is VA could refocus services on “its traditional group of patients — those with the greatest needs or fewest financial resources.”

It noted 90 percent of group 7 and 8 enrollees had other health care coverage.  Those who don’t could be eligible for health insurance exchanges in the future.

One disadvantage is that many veterans who rely on VA for at least part of their medical care would see that care interrupted.

The Obama administration and Congress had been moving to expand VA enrollment, until Republicans won the House. As Obama took office in 2009, VA announced that up to 266,000 veterans with no service-connected health conditions would be allowed to enroll in VA health care. Rep. Chet Edwards, D-Texas, had fought successfully to add $350 million to the 2009 VA budget so income thresholds controlling priority 8 enrollments could be raised 10 percent.

Edwards lost his reelection bid last year.  And new priority 8 enrollees haven’t rushed to join the system.

Group 8 and 7 veterans using VA care pay $15 per outpatient visit and a little more for specialty care.  Inpatient fees also are modest.  The most popular benefit for many of enrollees is discounted prescription drugs. The co-pay usually is $8 for a 30 day supply.

Tim Tetz with American Legion said his organization and many veterans groups would strongly oppose tossing out group 7 and 8 veterans.  He credits their enrollment since 1999 as helping to improve VA care.

“If as great of a health care system as we have, shouldn’t we let all of our veterans have access to it, in some manner,” Tetz asked.

While deficit hawks weigh this issue, VA still is enrolling new group 8 veterans who fall below its income thresholds. Those without dependents and living outside high-cost areas, for example, must have income below a means test threshold of $32,342.  More information on group 8 enrollment is online at www.va.gov/healtheligibility or call (877) 222-8387.

DAV vans

The Disabled American Veterans (DAV) organization is running a VAHC van from Durango on Tuesdays and Thursdays, call (505) 239-2769, and from the Farmington area on Mondays and Wednesdays, call (505) 793-2915 or (505) 325-4775.

Durango VA Clinic

The Durango VA Outpatient Clinic is located at 1970 E. 3rd Ave., Durango, C) 81301 (The old Mercy Medical Center). The phone number is (970) 247-2214.

Further information

For information on these and other veteran’s benefits, please call or stop by the Archuleta County Veterans Service Office located at the Senior Center in the Pagosa Springs Community Center on Hot Springs Blvd. The office number is 264-4013, the fax number is 264-4014, cell number is 946-6648, and e-mail is afautheree@archuletacounty.org.

The office is open from 8 a.m. to 4 p.m., Monday through Friday. Bring your DD Form 214 (Discharge) for application for VA programs, and for filing in the VSO office.

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