Hundreds of thousands of veterans of earlier U.S. military conflicts might also no longer qualify for VA health care or might be forced out by rules proposed by the Bush administration to relieve an overburdened system. The changes would increase veterans’ out-of-pocket costs by increasing co-payments for out-patient care and prescription drugs, as well as require many to pay a $250-a-year enrollment fee just to stay in the VA health-care system.
That, critics say, will force many veterans to say goodbye to a health-care system they had assumed would be available all of their lives.
VA officials say they must focus on veterans with the greatest needs – those with the most serious service-related illnesses and injuries and those too poor to afford other health care.
But many veterans – and the organizations that represent them – say it is a broken promise.
“Young men and women go off and fight for their country and are told that their needs will be taken care of,” said Ronald Conley, national commander of the 2.8-million member, Indianapolis-based American Legion. “To change the rules on them when they get back is wrong.”
The Bush administration’s proposed changes cut off enrollment for veterans who make more than about $24,000. Those who are above that threshold and are already enrolled in the system would have to pay an annual $250 fee to keep their health-care benefits. In addition, the Bush administration is proposing increasing co-payments for higher income patients from $15 to $20 per outpatient visit and from $7 to $15 for prescription drugs.
The Republican-controlled Congress recently passed a budget for veterans’ health care of about $30 billion for 2004, an increase of about $3.4 billion over this year’s budget. [Republicans had earlier voted to cut $25 billion.] But the Democrats say some of this money will have to come from co-payments and the veterans using the system.
“They are squeezing people out of the system and making those left behind pay,” said U.S. Rep. Ted Strickland, D-Lucasville, a member of the House Veterans Affairs Committee. “It’s just wrong.”
Republicans in Congress say Democrats like Strickland are misleading veterans, saying that the Bush administration proposals are not included in the budget document and aren’t likely to be passed on their own. It could be fall before any decisions are reached.
Strickland said Congress would need to approve increases in co-payments, but the VA could act on its own on re-enrollment fees.
In 1996, Congress mandated that the VA adopt an enrollment system to manage health care for veterans. It gave the VA secretary the power to decide each year whether to continue to allow all veterans to enroll.
What the VA came up with is an eight-tiered system that ranks veterans in terms of their medical needs. The “Priority 1” category includes veterans with service-related disabilities rated 50 percent or more disabling. At the bottom is the “Priority 8” category – veterans without service-related disabilities who are above the $24,000 income threshold.
On Jan. 14, 2002, Veterans Affairs Secretary Anthony Principi issued a directive saying that Priority 8 veterans could no longer enroll for VA health care. The VA, he said at the time, “is maintaining its focus on the health care needs of its core group of veterans – those with service-connected disabilities, the indigent and those with special health-care needs.”
It is a rule that will exclude an estimated 173,000 veterans.
Strickland recently asked the House Committee on Government Reform what impact the rule changes would have on VA health in Ohio. The study estimated that about 4,000 would be prevented from enrolling and another 41,000 might be forced out of the system because of the additional out-of-pocket costs.
“Me and the president and every other politician I know loves to have his picture taken with a group of veterans in uniform; we’ll all be doing it on Memorial Day weekend,” Strickland said. “But this is the reality.”
Tim Culbertson, a 50-year-old Army veteran from Cheviot who was wounded in Vietnam, has a VA disability rating of 50 percent and receives regular treatment at the VA Medical Center in Cincinnati. Culbertson often steers veterans through the maze of red tape, helping them get medals that were earned but never awarded and hooking them up with the VA system. He said he believes excluding veterans from health care is wrong.
“This country is sending billions to Turkey, and they wouldn’t even let us station troops there,” Culbertson said. “And we’re going to have people coming back from Iraq who will probably never get VA health care. There’s something wrong with that picture.”
The VA will give returning Operation Iraqi Freedom veterans something the veterans of the first Persian Gulf War did not get – two years of free VA medical care. But, after that, they will have to show service-related disabilities and meet the other requirements to keep the service.
Conley, the American Legion’s national commander, said he believes the two years of free health care may not do the Iraq veterans much good.
“It took longer than two years after Vietnam for Agent Orange to start showing up, or PTSD (post-traumatic stress syndrome),” Conley said. “We don’t know what some of these young soldiers and Marines might develop somewhere down the line because of their service over there. Two years is not enough.”
It is not just recent veterans who might be excluded. World War II veterans are now elderly, and most have some kind of health problem – service related or not. The Vietnam generation of veterans is reaching its 50s now – an age when health problems become more common.
Conley, the American Legion commander, said he talked to a WWII veteran in Tennessee last week who was a prisoner of the Japanese and a survivor of the Bataan Death March. He was rated as having a disability when he left the service, but now, in his early 80s, he needs health care and doesn’t qualify because of his income and his zero percent disability rating.
“This is a man who made it through the Bataan Death March, who saw all kinds of hell serving his country,” Conley said. “And now they’re telling him he can’t enroll for health care. It’s crazy.”
Focusing on those who need help the most, VA officials say, will help relieve what has been a chronic problem at the nation’s VA hospitals – long waits for veterans seeking health care. In July 2002, the VA reported to Congress that 310,000 veterans nationwide had waited six months or more for an initial appointment with a VA doctor. From 1996 to 2002, the number of patients being treated by the VA jumped by 54 percent.
The priority system is aimed at cutting those long lines and long waits, but some are not sure that the priority system is doing what the VA intended it to do – get the care to those who need it the most.
“The priority system looks good on the outside, but it doesn’t always work that way,” said David Gorman, executive director of Disabled American Veterans (DAV), an advocacy group that began in Cincinnati 83 years ago. “VA doctors are like doctors anywhere. They treat the people who come in the door. They don’t worry about who is ranked where. They worry about treating patients.”
Gorman, a Vietnam veteran who has a VA disability rating of 100 percent, receives VA treatment.
“I go to the clinic, and I’m sitting there next to some 82-year-old World War II guy who has no service-related disability but who is obviously hurting, and I feel bad about going in to see the doctor ahead of him,” Gorman said.