When members of the military finish their service, most of them don’t anticipate having to fight for health insurance and medical care on the home front. Some of the country’s 24 million veterans face unaffordable health insurance premiums and lack of access to government-run hospitals and clinics -- far from the hero’s welcome they expected.
“I had the notion that I was a hero and everything was taken care of, but nothing turned out,” says 63-year-old Rick Long, who served with the Army in Vietnam and struggled for 40 years to find health insurance.
The plight of military veterans seeking health insurance is a prime example used by groups advocating a national health care program. An estimated 1.46 million, or 13 percent, of veterans under age 65 are uninsured, according to 2008 data.
An often-cited study by researchers at Harvard Medical School estimated that 2,266 uninsured military veterans under 65 died in 2008 because of limited access to health care. They’re among the 45,000 Americans who Harvard researchers say die each year because they lack health insurance.
“The biggest surprise is that there’s any uninsured veterans,” says Dr. Steffie Woolhandler, whose Harvard team analyzed U.S. Census Bureau data. “It’s particularly egregious that people who are veterans, including combat veterans, can serve their country and still not have a right to health care. This is a common, ubiquitous, everyday occurrence that a veteran doesn’t have health care. That’s the problem here.”
Fighting for care
Long first was denied by private companies and what now is the U.S. Department of Veterans Affairs (VA), which would not acknowledge that his injuries, including cancer on his back, stemmed from Agent Orange exposure during his military service from 1966 to 1969.
“From what I understand, it’s the norm,” says Long, who lives near DeLand, Fla. “The few friends that I do remember from Vietnam that I’ve been in contact with, they’ve had the same problem.”
When private insurance did become available through work, the cost was too high -- as much as $1,500 a month. For years, Long jumped through many hoops, turning in paperwork and being denied or not having enough proof of his injuries. The paperwork included requirements that he cite the names, dates and locations of the Vietnam battles that he fought.
Finally, after paying an estimated $30,000 for medical care related to cancer and heart disease, Long was deemed about five years ago to be disabled, resulting in medical care through the VA. It’s still not a perfect scenario, with restrictions that require him to schedule procedures months in advance and even set a timeframe for calling an ambulance.
Eligibility depends on service, income
VA and the U.S. Defense Department operate the U.S. military health care programs.
The Defense Department’s Tricare program provides government-subsidized medical and dental care through contracts with civilian-managed health care providers. About 9.6 million active-duty personnel and their families and retirees are covered by this program.
The Veterans Health Administration, a VA branch, runs the nation’s largest health care system. It expects to provide care to more than 6.2 million patients in 2012 (up slightly from 2011) at hospitals, outpatient clinics, residential rehabilitation treatment programs, nursing homes and counseling centers.
Veterans who incurred an injury or illness in service are eligible for VA care, and all military members have a five-year window after leaving service to access VA for all medical needs. The group of veterans who encounter the biggest problem with health care are up against these three challenges: less than 20 years of service (and therefore aren't eligible for Tricare), did not suffer injuries in service that make them eligible for VA care and cannot find affordable insurance in the private sector.
“Certainly, those people are having problems. There is no debating that,” says Mark Seavey, a spokesman for The American Legion and a former congressional lobbyist.
Veterans must pass a "means test" to determine eligibility to go to VA facilities for treatment of illnesses, chronic conditions like diabetes or high blood pressure or injuries not received in service. Veterans who enroll for VA health care benefits are assigned to a priority level -- categories 1 through 8 -- that takes into account income and service-related disabilities. Those placed in Category 8 are not eligible for care. Income thresholds vary by location, such as $39,400 in Topeka, Kan., or $68,800 in San Francisco. Those dollar figures are for a veteran with one dependent.
“Many uninsured veterans earn just a little bit too much to qualify for the means test and yet they’re too poor to afford private insurance,” says Woolhandler, now a professor at the CUNY (City University of New York) School of Public Health at Hunter College. “Like the uninsured generally in this country, they’re too affluent to qualify for Medicaid and not affluent enough to afford the price of private insurance.”
Even for those with coverage, the costs are rising. The Tricare program, for military retirees who served at least 20 years, has seen a price increase – the first one in 15 years. The hike, which took effect in October 2011, amounts to $5 a month for family coverage.
A cry for help
Organizations such as VoteVets.org and the AFL-CIO have given veterans struggling with medical care the opportunity to post their stories online. Some of these veterans are self-employed. Others are unemployed, representing 8 percent of veterans. Many no longer can afford private insurance and have found difficulty in getting VA care.
One of the insurance casualties is Michael Baranik, a Navy veteran from Jennings, La., who recounted how he learned about his cancer and his insurance limitations in the same meeting with a physician. In a posting on Guaranteed Healthcare, a project of the California Nurses Association/National Nurses Organizing Committee, the Navy veteran wrote in 2008:
“In January 2007, on the worst day of my life, I sat in a doctor's office and was told I had terminal cancer, then in the next breath he told me my insurance was not good enough to cover reimbursement of the chemotherapy … I thought my military insurance was good coverage and was accepted by most doctors. What I found out was most doctors are not accepting military insurance. I had to go and beg doctors to give me a chance to live. I was shocked and the unpatriotic sense these people have. I will never in my life recommend any person join our armed services. Why should they? So they can get sick and be told, sorry, we know you fought for our country, and this is how we repay you ... NO MEDICAL CARE. ... It is insane and un-American.”
Baranik died in 2010.
'We owe them better'
In early 2011, Veterans Affairs Secretary Eric Shinseki acknowledged to a congressional committee that VA’s obligations to veterans, including medical care, have not always been upheld. “We, who sent them, owe them better,” he said. Discussing VA's goals for 2012 and 2012, Shinseki said his agency is striving to reverse ineffective decision-making, systematic inefficiencies and poor business practices in order to improve VA health care as well as other benefits and services.
Shinseki said in a statement released in February 2011 that he's committed to transforming VA into "a 21st century department that leads the nation in high-quality health care.”
One of the ways Shinseki envisions doing that is by employing a team approach -- with professionals from a variety of medical specialties -- to emphasize wellness, disease prevention and chronic disease management in VA's primary care programs. "The new model of care will improve health outcomes and the care experience for our veterans and their families," Shinseki, a retired Army four-star general, told a congressional committee in March 2011.
For his part, Long, the Florida veteran, says it should be simpler for military veterans to obtain health insurance.
“I think it was ridiculous what I had to do,” Long says. “But now that I do have it, I appreciate it.”