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Saturday, December 01, 2007

States Move to Assist Uninsured Veterans

This was a big story in mid-October, as it should have been. Before updating on the response to the uninsured veteran problem in two states, Illinois and Wisconsin, a data recap via AP:

Nearly 1.7 million military veterans have no health insurance or access to government hospitals and clinics for veterans, according to a report Tuesday from a doctors' group that favors federally financed health care.

The number of uninsured veterans jumped by 235,000 since 2000, meaning they are losing health insurance at a faster rate than the general population, said Physicians for a National Health Program, which advocates a universal national health insurance program. About 45 million Americans have no health insurance, including 5 million who lost coverage during the past four years, according to the Census Bureau.

"We're sending men and women off to war and yet the people who fought previous wars can't get the basic things they need to go on with their lives afterward," said Dr. David Himmelstein, a Harvard Medical School professor and an author of the study.

In educational interest, article(s) quoted from extensively.


White House spokesman Trent Duffy said the Bush administration has opened 194 community health clinics for veterans and increased spending on medical care for veterans by 40%. "The president wants to make sure they get the care that they need and they deserve," Duffy said.

However, the report traced some of the increase to the Bush administration's decision last year to suspend health care services for higher-income veterans in order to reduce waiting times for doctor's appointments.

Other veterans reported that they were on waiting lists for appointments, could not afford co-payments or lived in communities with no veterans' facilities, the report said. Like other Americans who are uninsured, most veterans have jobs. More than 85% worked within the past year, the report said.

Many uninsured veterans reported serious health problems, the report said. Between 20% and 30% said that they delayed or could not afford care, medications and eyeglasses. More than 40% said they had no medical visits in the past year and two-thirds said they had no preventive care. Another 3.9 million people without health insurance live in veterans' households and also are ineligible for veterans' health care, the report said.

Almost all uninsured veterans served during the Vietnam war or more recently. Those who fought in World War II and the Korean War are older than 65, making them eligible for government health care through Medicare.

Additional details from PNHP:

Of the 47 million uninsured Americans, one in every eight (12.2 percent) is a veteran or member of a veteran’s household, according to a study by Harvard Medical School researchers published in the December, 2007 issue of the American Journal of Public Health (galley version [pdf]). ...

The study is based on detailed analyses of government surveys released between 1988 and 2005. Veterans were only classified as uninsured if they neither had health insurance nor received ongoing care at Veterans Health Administration (VA) hospitals or clinics. A preliminary review by the study’s authors of 2006 data released last month (while this study was in press) shows little change in the number of uninsured veterans since 2004.

“Like other uninsured Americans, most uninsured vets are working people - too poor to afford private coverage but not poor enough to qualify for Medicaid or means-tested VA care,” said Dr. Steffie Woolhandler, an Associate Professor at Harvard Medical School who testified before Congress about the problem earlier this year. “As a result, veterans and their family members delay or forgo needed health care every day in the U.S. It’s a disgrace.”

Other findings of the study include:

* The number of uninsured veterans has increased by 290,000 since 2000, when 9.9% of non-elderly veterans were uninsured, a figure which rose to 12.7% in 2004.

* Of the 1.768 million uninsured, 645,628 were Vietnam-era veterans while 1,105,891 were veterans who served during “other eras” (including the Iraq and Gulf Wars)

* Of uninsured veterans, 56.5% were older than 44.

* Uninsured veterans had as much trouble getting medical care as other uninsured persons. 26.5% of uninsured veterans reported that they had failed to get needed care due to costs; 31.2% had delayed care due to costs; 49.1% had not seen a doctor within the past year; and two-thirds failed to receive preventive care

* Nearly two-thirds of uninsured veterans were employed.

States across the nation are responding to this and other reports. Illinois, for example, is tweaking its uninsured veterans program:

Department of Veterans' Affairs Director Tammy Duckworth said Friday current eligibility rules for the Veterans Care insurance program exclude many veterans who could benefit from it.

"We are rewriting the rules," Duckworth said. "Unfortunately, some of the (original) rules did not address the situation of veterans today." Duckworth blamed the rules for the small number of Illinois veterans who have signed up for the program. More than a year after the state started taking applications, Veterans Care has "somewhere over 100" veterans enrolled in it, Duckworth said. Initial estimates were that thousands of Illinois veterans might qualify.

"It's not very high," Duckworth said. "That's because of the restrictions."

For example, a veteran cannot enroll in Veterans Care if he or she has access to other health insurance. Members of the Illinois National Guard and Reserve drill one weekend a month, during which time they are covered by federal Veterans Administration health care.

"For those two days of the month, they have health care, and that eliminates their eligibility for Veterans Care," Duckworth said. She also wants to allow some veterans to enroll in Veterans Care, even if they qualify for health care under the Veterans Administration. Veterans would be eligible if they live more than 50 miles or more than an hour's drive away from the nearest VA facility, she said.

"If you live in El Paso, Illinois, you don't have access to VA health care. You are too far away," Duckworth said. Another problem, she said, is that even if a veteran is eligible for federal health care, he or she may have difficulty getting it on a timely basis. In some cases, veterans wait months or even years to get appointments for VA health services.

"To me, that is the same as not having access," Duckworth said. She acknowledged that if eligibility rules are changed and more veterans participate, the cost to the state will go up. Veterans Care is funded with a combination of state money and proceeds from a special state lottery game.

Still, Duckworth said, the program will maintain income requirements and other rules that will keep Veterans Care focused on those who really need it.

And to the north, in Wisconsin:

Some statistics don't sit well with state Rep. Steve Hilgenberg, D-Dodgeville. When he read a study from Harvard Medical School that 1 of every 8 veterans under the age of 65 is uninsured, Hilgenberg was surprised, and moved to action.

Hilgenberg said he will introduce the Veteran Interim Health Care Bill within the next two weeks. Under the bill, Wisconsin's uninsured veterans will receive 24 months of affordable health insurance with low monthly premiums and conservative co-pays.

"These troops are stressed enough getting out of combat," Hilgenberg said. "They shouldn't need to worry about health insurance coverage." ... The plan would be geared toward working veterans who do not have access to health insurance, either because they make more than is allowed to access Veterans Affairs health care, their employer does not offer health insurance or they cannot afford a private policy.

"We owe veterans the opportunity to recuperate and reshape their lives on return to civilian life with access to affordable medical care," Hilgenberg said. "It is so important that we do everything possible to protect our Wisconsin veterans."

Hilgenberg said the Department of Veterans Affairs would operate the program, which he estimates would cost the state about $2 million. Hilgenberg said the money would come out of the state's general purpose fund.

The Legislative Fiscal Bureau is working on costs for the coverage, premiums and co-pays. Hilgenberg estimates the monthly premiums would be around $50. He had no estimates on the co-pay structure.

Hilgenberg said veterans, upon returning home from service, would have to apply for the coverage. Once the VA determined a veteran was eligible for the insurance, the two-year coverage would start.

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