For veterans, health-care law offers new options — and
By Michelle Andrews, Published: May 6
Military veterans will have more health insurance options under the
Affordable Care Act, but some vets, like many Americans, may still
struggle to find affordable, accessible care that meets their needs.
Roughly 40 percent of the 22.3 million military veterans receive
health-care services from the Veterans Health Administration, which
operates a nationwide network of medical centers, hospitals and clinics.
Many veterans are eligible for both VA health care and Medicare,
Medicaid or Tricare, the health plan for active and retired military and
their families. About half of veterans have private insurance;
approximately one in 10 veterans younger than 65 are uninsured.
Veterans who were honorably discharged after being on active duty for at
least two years may qualify for VA health services. Since funding for
the VA health program is limited, however, priority is given to veterans
who have service-related disabilities or low incomes.
Although there are no premiums for VA health care, some veterans may owe
co-payments for services. Veterans who return from active military duty
are typically eligible for free VA health care for five years.
Under the Affordable Care Act, most people will have to have health
insurance starting in January or pay a penalty. Veterans who are
enrolled in VA health care won’t have to buy additional coverage,
although they can supplement their coverage if they want to.
Mike Sage, 64, a Vietnam War combat veteran, pays $15 per visit for
primary-care services and $50 for specialist care at the VA clinic near
his home in Monmouth, Ill. Prescription drugs are $8 for a 30-day
supply. But his wife, Kay, like many veterans’ spouses, doesn’t qualify
for VA health care. They plan to check out the policies offered on the
Illinois health insurance exchange this fall to see if there’s a better
option than the catastrophic-coverage plan with a $5,000 deductible that
she currently carries.
Kay Sage might qualify for a premium tax credit for coverage on the
exchange if the couple’s household income is between 100 percent and 400
percent of the federal poverty level ($15,510 to $62,040 for a family of
two in 2013).
The expansion of Medicaid under the Affordable Care Act — which states
are currently wrestling over whether to implement — could also affect
veterans’ health care. The law allows the expansion of the federal-state
program for low-income people to include adults with incomes up to 138
percent of the federal poverty level ($15,856 in 2013).
According to an analysis published by the Urban Institute last month,
four in 10 uninsured veterans have incomes below 138 percent of the
federal poverty level, potentially enabling them to qualify for Medicaid
if their states expand the program. Most of those veterans have incomes
below 100 percent of the poverty level.
“For these veterans, it’s critical that their state expand Medicaid,”
says Jennifer Haley, a research associate at the Urban Institute who
co-authored the report.
In states that don’t expand their programs, veterans whose income falls
below 100 percent of the poverty level will generally not qualify for
Medicaid, nor for subsidized coverage on the exchanges.
Even though a non-disabled veteran may meet the income threshold for VA
health care — nationally, about $34,000, further adjusted by geographic
location — he or she may not live near VA facilities or know that VA
care is available, according to the report.
At a hearing last month before the House Committee on Veterans’ Affairs,
VA officials said they expect a net increase of 66,000 veterans seeking
health care through VA facilities when the mandate to have health
insurance kicks in next year.
Some veterans will come into the VA system but others will leave to seek
coverage on the exchanges or through Medicaid, they said. Those who are
eligible for more than one health program may pick and choose, using one
program for cheaper prescription drugs, for example, and another for
But more choices may not mean better care, says Kenneth Kizer, director
of the Institute for Population Health Improvement at the UC Davis
In an opinion piece published last year in the Journal of the American
Medical Association, Kizer, a former VA official, noted that having
access to multiple plans can lead to fragmented care, increasing the
chances of errors and other complications.
“Tests get repeated, drugs get prescribed that may not be compatible
with each other,” he says. “One provider may not realize what the other
This column is produced through a collaboration between The Post and
Kaiser Health News. KHN, an editorially independent news service, is a
program of the Kaiser Family Foundation, a nonpartisan
health-care-policy organization that is not affiliated with Kaiser
Permanente. E-mail: email@example.com.
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