Some U.S. military veterans face a battle to get the health care they need – and many wind up uninsured. But experts say federal health care reform, also known as Obamacare, will give many vets more health care options.
The Affordable Care Act (ACA), the federal health care reform law passed in 2010, requires most individuals to have health insurance or pay a fine starting in 2014. However, the ACA counts the network of hospitals and clinics operated by the U.S. Department of Veterans Affairs (the VA system) as qualifying insurance coverage. Therefore, veterans enrolled in the VA system meet the ACA individual mandate.
How do veterans get health insurance?
Right now, experts say veterans get health care in three primary ways, which often overlap:
1. The VA health system
About 37 percent of veterans get care through the VA system, according to veterans’ health care expert Kenneth Kizer, stated in “Veterans and the Affordable Care Act,” an editorial published in the Journal of the American Medical Association in February 2012.Because VA system funds are limited, certain groups of veterans, such as those with a severe disability related to their military service and those with very low incomes, are given priority for care.
2. Other government programs
Many veterans have several types of coverage. For example, 80 percent of veterans over 65 who get VA care also have Medicare, according to Kizer. And, about 25 percent of VA enrollees also get care through two or more other government programs, such as Medicaid or Tricare, a program run by the U.S. Department of Defense that provides coverage for active duty service members, military retirees and their dependents and survivors.
3. Private health insurance
About 56 percent of veterans have either private health insurance or coverage through a non-VA federal program such as Medicare, Medicaid or Tricare, according to Kizer.
Despite these programs, 10 percent of the 12.5 million U.S. veterans under 65 have neither private health insurance nor coverage through the VA system, according to a 2012 analysis by the Urban Institute, a non-partisan organization that analyzes social and economic issues. Overall, uninsured veterans are younger, have lower levels of education and are less likely to be married than insured veterans, according to the report. Many lack access to employer-sponsored coverage but do not qualify for Medicaid. But experts say the federal health care reform law will give many veterans more health care options.
However, the effect the law will have on VA system enrollment is not known, according to Carl Blake, national legislative director for the nonprofit Paralyzed Veterans of America (PVA). That’s because veterans have choices: they can comply with the ACA by enrolling in the VA system or by buying private insurance through an exchange, he says. The VA estimates that 66,000 veterans could enroll in the VA system as a result of the ACA, while PVA states that number could be much higher.“There are still a lot of unanswered questions,” Blake says.
3 ways Obamacare will help veterans
In any case, experts agree that more veterans will get coverage. Here are three major ways experts say Obamacare will help veterans:
1. Expansion of Medicaid will allow more veterans to qualify.
Current eligibility for Medicaid is based on income and other factors. So, non-disabled adults who are not pregnant or caring for dependent children don’t qualify in most states.The ACA will provide for an expansion of Medicaid so that those making less than 138 percent of the federal poverty level will be eligible for Medicaid based solely on income. However, this change will apply only in states that choose to expand the program since a 2012 Supreme Court decision allows states to opt out. Governors in 14 states, including Texas, Pennsylvania and Maine, have announced plans to opt out. So, whether low-income veterans will be eligible depends on where they live.
A 2013 analysis by the Urban Institute found that four out of 10 uninsured veterans could qualify for Medicaid in states that expand. That means Medicaid expansion will play an important role in coverage for veterans, says Jennifer Haley, a research associate for the Health Policy Center at the Urban Institute.
2. The exchanges will offer another option for veterans and their families.
Many uninsured veterans have low incomes but still make too much to qualify for VA system care, according to Kizer. Starting in October 2013, individuals will have the option of buying health insurance through the exchanges, the health insurance marketplaces being set up as a result of health care reform. “The exchanges will be a good option [for veterans],” Haley says.
But individuals with incomes of less than 100 percent of the federal poverty level won’t be able to get subsidies to offset the cost of premiums, she says. Experts say that’s because lawmakers had assumed those individuals would get Medicaid. According to the Urban Institute analysis, most of the veterans who would qualify for Medicaid in states that expand make less than 100 percent of the federal poverty level, and those veterans could be left struggling to find health care, Haley says.
3. Other provisions in the ACA will help veterans.
Insurance companies that sell plans in the exchanges will have to accept applicants with preexisting conditions and aren’t allowed to charge them more. This will benefit veterans, according to a statement from the Paralyzed Veterans of America website. PVA also states that Obamacare provisions that provide for long-term home care also make it more likely that veterans will be able to stay in their homes rather than having to move into nursing homes or other institutions.
However, certain provisions in the ACA could create problems for veterans, experts say. Veterans enrolled in the VA health system cannot get tax credits to offset the cost of buying private health insurance in the exchanges. According to an official Paralyzed Veterans of America statement submitted in April 2013 to the House Committee on Veterans’ Affairs, this could create problems for veterans who use the VA for specialized care such as spinal cord rehabilitation, but who use private insurance for basic care because they don’t live near a VA facility.
“If the closest VA facility is far away, it might not be a convenient option,” Haley says.