Original Content at http://www.opednews.com/articles/life_a_vi..._u_s__veter.htm June 27, 2007

1,800,000 U.S. VETERANS HAVE NO HEALTH CARE

By Victor Martinez

As the nation struggles to improve medical and mental health care for
military personnel returning from Afghanistan and Iraq, about 1.8
million U.S. veterans under age 65 lack even basic health insurance or access to care at Veterans Affairs hospitals, a new study has found.

The ranks of uninsured veterans have increased by 290,000 since 2000, said Stephanie J. Woolhandler, the Harvard Medical School professor who presented her findings yesterday before the House Committee on Veterans Affairs.

About 12.7 percent of non-elderly veterans -- or one in eight -- lacked
health coverage in 2004, the most recent year for which figures are
available, she said, up from 9.9 percent in 2000. Veterans 65 and older are eligible for Medicare. About 45 million Americans, or 15 percent of the population, were uninsured in 2005, the Census Bureau reports.

"The data is showing that many veterans have no coverage and they're sick and need care and can't get it," Woolhandler said.

Woolhandler's findings are based on data from two national surveys --
the Current Population Survey administered by the Census Bureau and the National Health Interview Survey administered by the Department of Health and Human Services. Veterans who said they had neither health insurance nor veterans or military health care were counted as uninsured.

Woolhandler is a well-known advocate of guaranteeing access to health care for all Americans through a government-run national health insurance program. Republican lawmakers seized on that association to question whether she was trying to advance that goal with her study.

"The difficulty would be that because of your desire for universal
health care, that could influence how you felt about veterans," Rep.
Cliff Stearns (R-Fla.) said.

Woolhandler said the data are sound. She has firsthand experience with the issue as well, she said, because as a physician she has seen
uninsured veterans with untreated high blood pressure, diabetes and
other conditions.

"It breaks my heart," she said. "The VA should be an important safety
net for my patients, and it's not."

Nearly 8 million veterans were enrolled in the VA health system in 2006. The focus of the hearing was whether to open VA hospitals' doors to so-called Priority 8 veterans, who have no service-connected
disabilities and whose earnings generally are above 80 percent of the
median income where they live.

Doing so would add significantly to VA's caseload and costs -- estimates range from $366 million to $3.3 billion annually -- and some veterans groups and lawmakers are concerned that it would make it harder for veterans with serious service-related health problems to get timely care.

Only about half of the 1.8 million uninsured veterans are classified
Priority 8, Woolhandler said. The rest may technically be eligible for
some VA care but live too far from its facilities for it to be a real
option, she said.

Rep. Steve Buyer (Ind.), the committee's ranking Republican, said
Veterans Affairs should focus on its "core constituency" -- veterans
with service-related health problems, the indigent and those with
"catastrophic" disabilities.

"Some say the government is obliged to provide essentially free health care for life to anyone who served even a year or two," he said. "I intend to protect the core constituency first."

But Rep. Bob Filner (D-Calif.), the committee's chairman, said taking
care of veterans is a continuing cost of war. "All veterans should have
access to 'their' health-care system," he said. "This is rationing
health care to veterans, those who have served our nation. And I think it's unacceptable for a nation of our wealth and our ability."





Back

Methinks the whole premise of the above article is at best misleadin', but maybe is actually dishonest, eh? Any veteran of U. S. military service (as defined in Title X of the United States Code) and honorably discharged is eligible to apply for VA medical bemefits!

Are these 1,800,000 U.S. veterans that the article claims have no health care all reciprients of dishonorable discharges? Maybe they've just not bothered to apply? Tough to figure, and methinks the article, unless I missed it, gives no clue.

Politicians and ideologues've frequently used hyperbole and dishonest rhetoric on veterans' issues as a wedge issue for a long time, eh? IMHO this article is an indication it continues. For a real good example of how it's been used in the past methinks a visit here'd be an eye opener.

Here are a couple of sites about veterans' benefits, but I'm not certain what it all means and how the info might explain why so many veterans have no health care insurance.
http://www.va.gov/healtheligibility/Librar...s/CombatFAQ.asp
http://www.military.com/benefits/veterans-...are-eligibility

I don't know the answers to these questions: Fly, maybe you or other vets here know the answers.
Maybe there are no VA hospitals within reach?
Do vets have to be treated at VA facilities in order to have VA health coverage or can they go anywhere and the government will compensate the hopitals/doctors?
Are vets who are above the income eligibility requirements within the VA, not covered by other health insurance because they can't afford it?

This story is hoakum.

Every region in a place with the vast distances such as Texas has a VA clinic available if it's too far from a VA Hospital.

Some vets simply do not know they qualify for health care. Thats why the DAV holds informational outreaches. How you are classified in the VA system also has some bearing on your axcess to health care. The whole issue is not as simple as some would indicate.

So, what do vets do if the VA clinic and/or the VA hospital are too far?

The VA, like most of the rest of the American (and other modern countries) health care systems has started shiftin' the onus from large expensive and underutilized inpatient facilities to community based outpatient clinics, eh? As old antiquated and unsupportable hospitals've been closed they've been replaced by outpatient clinics, methinks at a ratio of somethin' like eight clinics opened for each hospital closed. That puts VA health care facilities within easy reach of almost all vets, the only exception bein' them who choose to live in more isolated areas.VA beneficiaries in certain categories and meetin' special requirements're eligible for a program called CHAMPVA, which pays for care in other'n VA facilities. Other'n that, like most health plans, they've got to go through participatin' health care facilities (in this case normally VA owned and operated), eh?If you look at the criteria methinks you'll find the income eligibility requirements are set at less that 80% over the local area median income. More'n that methinks you'll agree should be able to afford health on their own, but even these're offered VA care after payin' a relatively small ($500 I think) enrollment fee and then reasonable co-payments similiar to the TRICARE Prime program military retirees're under.IMHO this's a bunch of hooey! At least since the early 70s every member undergoin' separation outprocessin' been informed of and they've had to acknowledge their eligibility for VA benefits, includin' medical, and advised to make an appointment with a VA counselor to get set up - if they so desire. That some choose not to do so to me indicates a failure on their part, not the system's, eh? Let's not call lazy folks victims here, they was all grown up girls or boys when they got out of the service.Please define "too far", eh? Methinks if you use this site you'll find facilities within easy and/or reasonable reach of almost every eligible vet.

Nonsense. My brother in law was a Marine vet. I had to tell him he qualified for perscription drugs from the VA. The rules are complex for most people. Thats why the DAV provides guidance and other help to assist vets with the VA system. If any vet needs help with the VA I suggest they see the DAV to help them through the system.

Guess he didn't pay attention to the VA brief durin' separation processin' and probably never went to see the VA counselor after separation like was recommended, eh? Had he done so I'd be bettin' there'd have been no need for this.Methinks DAV and groups like them provide a valuable service for folks havin' problems figurin' out what exactly they're eligible for. Just the same, IMHO if them bein' separated would pay attention to what's bein' explained to them, and get in to see a VA counselor soon after separation there'd be less requirement to go into crisis mode to get their benefits when the need arises, eh? Folks can whine all they like, but methinks a little personal responsibility goes a long way.

Amy, I generally consider myself as pretty much living out in the boonies.

Even with living out here in the middle a nowhere I guess I'm lucky, I got the choice of a major VA hospital or three outpatient clinics within 35 miles a where I live.

I'm sorry but Victor Martinez just didn't find out the facts before he wrote this story.

Reviewing the Main Page of the news outfit who published this story it appears most of the writers they got are a bit deficient doing their homework before they put pen to the paper.

It may be relative to when they were separated. Two cousins, my brother and myself were all separated within several months of each other and we all had the same experience. Nothing, nada, not one word of advice or information was provided about future benefits or the Veterans Administration at the time of separation, in my case it was October 1970. I know this holds true for a multitude of vets my age.
Also to be considered is the fact that many of the bennies have changed. My uncle is receiving services now that hadn’t been considered in 1945.

New Mexico, the 5th largest state in land area has but one VAMC. Some vets travel as far as 300+ miles to receive their med services.

My brother in law was discharged in 1962. When he got old and needed drugs he did not even think of the VA. Things are not as simple as some would like them to be.

In New Mexico, many of these vets were drafted away from their farms and ranches. They had no choice in the matter of being remote. Do they not deserve some consideration? Or is this just an inconvenient truth?
We are fighting to up the mileage pay for these vets, to at least offset some of the expense in traveling to the VAMC.

andNew Mexico Veterans Health Administration facilities:

VA Health Care System
Albuquerque: New Mexico VA Health Care System

Community Based Outpatient Clinic
Alamogordo: Alamogordo Clinic
Artesia: Artesia Clinic
Clovis: Clovis CBOC
Espanola: Espanola CBOC
Farmington: Farmington CBOC
Gallup: Gallup CBOC
Hobbs: Hobbs CBOC
Las Cruces: Las Cruces CBOC
Las Vegas: Las Vegas CBOC
Raton: Raton CBOC
Santa Fe: Santa Fe CBOC
Silver City: Silver City Clinic
Truth or Consequences: Truth or Consequences CBOC

Vet Center
Albuquerque: Albuquerque Vet Center
Farmington: Farmington Vet Center Satellite
Santa Fe: Sante Fe Vet Center

Although methinks it could always be better, 'twould seem there be VA clinics pretty well spread throughout the state. For them that don't need inpatient treatment (which'd be almost all the way medical practice has evolved) 'twould seem travel shouldn't be as problematic as you describe, eh?

Funny how this works eh, when you’re very ill you have to do some serious driving or riding. When you’re not quite so ill there may be a clinic within a hundred miles or more, depending on where in the 5th largest state you live.
Things like MRI, CAT scans, isotopic bone scans and many other med needs are only available at the regional med center. Every day veterans are traversing New Mexico for their health care, we know more inpatient facilities are not practical. What we are after is an increase in the paid mileage for those traveling the greater distances.

Here is an example of the services available at an outlying clinic;
• Blood Draws (by appt only)
• EKGs (Electrocardiograms)
• Evaluations by Doctors
• Routine Lab Tests
• Social Work Services
Hours of Operation: Monday through Friday 8:00 a.m. - 4:30 p.m. (closed Saturday, Sunday and Federal holidays).
And keep in mind;
No walk-in appointments are available at facility. For appointments, call the clinic or go to Albuquerque.

I am at a loss to understand why some of you criticize those veterans who are having difficulty getting medical care. IMHO, our veterans deserve the best medical care out there. Period.

Yes, you're fortunate to have VA facilities so close. But what of those who don't? For instance, what about a vet who's having a heart attack or stroke. Obviously he/she needs immediate attention at the closest hospital. What then? Do VA benefits cover the acute care at a non VA hospital?

It looks to me like they need at least 2 more (Socorro and either Lordsburg or Deming) clinics, possibly 3 (Tucumcari) to be sure almost all vets are within 100 miles of a clinic.

How much would not needing appointments and allowing walk ins at the clinics help?

May be a wedge issue for you, for many it’s way more than that. Do you support a means test?
I’m 100%, priority group one, none of this directly applies to me. My brother who separated as a 1st Lieutenant Jan, 1970 with 1 Silver Star, 2 Bronze Stars with V, and two Purple Hearts, he is an Agent Orange Diabetic, yet he has to annually meet the means test. His income has been middle class but he exceeds the means and he is not entitled to the same health care at the same cost I am, (I pay nothing). Is this what you support, or should all like my brother be entitled?
There are no one fix fits all solutions, except IMHO every combat vet should be entitled regardless……..

Exactly

Tremendously.
Even more important would be for the government to pay the expenses for vets who need to use an emergency room closer to home. The way it is now there are only a very few exceptions to what the VA will pay outside their system.

In the 37 years I’ve been in the system it has seen vast improvements, none of which came to us without a fight. The VA has given us nothing; we have fought for our improvements which includes our clinics. New Mexicans have been fortunate because we actually have access to our elected officials, most of whom have supported New Mexico’s veterans. We know there is lots of room for improvement, we hope the current trend continues and we know it takes pressure on our politicians to make this happen.

It seems to me it shouldn't be terribly difficult to craft decent guidelines for using community hospitals and in some places I can see where it would make a world of difference.

If NM's only a little more'n 400 miles long and 400 miles wide with Albuquerque not quite in the center then how could this be the case in all but the rarest of situations? Could you please show where anyone here's done what you indicate? Methinks a couple of us've questioned the veracity of the article you posted in the first note of this thread and provided specific reasons for doin' so. We've also tried to fill in some blanks and provide sources for info, but IMHO that don't equate to folks here that "criticize those veterans who are having difficulty getting medical care", eh? It's a discussion where differin' viewpoints're presented, ain't that what CGCS is supposed to be here for? I'd be happy to apologize if you can show me where I'm wrong, and would expect the same courtesy if it's you that ain't got it right, eh?

In addition I've indicated that there're probably folks out there separated from military service after the early 70s who might not've listened too good when informed of potential VA benefits and/or who never bothered to see a VA counselor to get enrolled and so ain't takin' advantage of what they're entitled to. Amy and I've provided links to get more info on what's available and where, Vaughn and tomhye indicated where, even though many more clinics have opened, there's probably room for more improvement (methinks the 40 new VA clinics openin' this year, and them scheduled to be openin' in subsequent years'll help address these problems of locale), and Amy's asked 'bout emergency care at non-VA facilities under current law.If I ain't mistaken there've been more'n a few news articles, includin' some posted here on CGCS 'bout the high quality of care in the VA system puttin' it ahead of the civilian health care delivery system in this country. 'Twould seem the VA's tryin' to make it even better for everyone too. It'll never be perfect, nor will it ever satisfy everybody, but methinks it also ain't near as bad as some'd have us believe. Unfortunately eligible beneficiaries do hafta make the effort to enroll in the VA system though, eh?andMethinks this. might be of interest (available here in html format). It indicates how 'bout seven years ago Congress provided VA with new authority to pay for emergency care in non-VA facilities for veterans enrolled in the VA health care system, eh?

In when what's covered it specifically states "The care must have been rendered in a medical emergency of such nature that a prudent layperson would have reasonably expected that delay in seeking immediate medical attention would have been hazardous to life or health" and says you must present for care in a designated emergency room. Also "If you are an eligible veteran, a VA facility is not feasibly available, and you believe your health or life is in immediate danger, report directly to the closest emergency room. You, your representative, or the treating facility should then contact the nearest VA as soon as possible (within 48 hours) to arrange a transfer to VA care, if hospitalization is required.", eh? That methinks is pretty straightforward. There's even more information available here for anyone interested.Methinks you'll find those type of diagnostic tools're rarely available in anything but the biggest fully equipped facilities in any health care delivery system. Methinks that's probably the same for most local private health care providers, even hospitals, unless you present to the emergency room. I don't understand how this's a problem, and if it's thought to be an emergency there's provision for immediate treatment, as described above.

I'm a bit curious 'bout the specifics of New Mexico others here've brought up. Do folks there have to drive as far for state services and facilities (e.g. gettin' a driver's license) as they do to get to a VA medical facility? Are some NM vets closer to VA facilities in AZ, UT, CO or TX and do they use them? Is there any other health care delivery system (government or private) with facilities more widespread and/or better situated to cover everyone anywhere in the state?

I am of the belief that any veteran, who has been in a combat or war zone, should have medical coverage (through the VA) that would allow them to seek medical care at any facility in the U.S. If they are covered under medicare or medicaid they should have additional coverage that would allow them to seek out the best care for their medical problems. Anyone agree with me on this?

I would go so far as to say that any veteran (there is always the risk of being called up to combat or war zone, after all) should have medical coverage, upon honorable discharge, granted by the VA that would allow them medical care at any facility in the U.S. that accepts Medicare or Medicaid, without regard for whether said vet is otherwise eligible for Medicare or Medicaid.

It's the least we can do for their service to our country.

I agree about all veterans having the best medical coverage by the VA. I'm wondering if that proposal wouldn't gain much momentum because of the cost...but I agree that's the way it shoud be.

If anyone can say "the government owes this to me" it's veterans.

I AGREE. To be clear, I believe the taxpayers should pay the full freight of the costs. Life time benefits. No means testing. No nada.

Survey Looks at Veterans' Care Problems
By HOPE YEN 06.29.07, 5:09 PM ET


A presidential panel said Friday it was compiling a first-of-its-kind national survey to determine scientifically the extent of health care problems for veterans returning from Iraq and Afghanistan.

Speaking in its last public hearing before considering final recommendations, the nine-member commission said its final report could shed light on a long point of dispute in the veterans' care debate: whether highly publicized horror stories of lost paperwork, delays in disability benefits and other problems are more isolated or significantly widespread.

"With this survey, we should be able to say some things in a more systematic way," said former Health and Human Services Secretary Donna Shalala in an interview. "One thing that will make our report truly different is that it will be evidence-based, based on the current science and present-day practice."

Former Sen. Bob Dole, R-Kan., who co-chairs the panel with Shalala, said he wasn't ready to put the moral weight of a presidential commission behind findings and recommendations until he saw some actual numbers.

"We don't want a bunch of Band-Aids that further complicate the system and create more problems," Dole said. "Observations sometimes don't translate to reality."

Their comments came as the commission began honing in on a set of findings and recommendations for their final report on improving care to President Bush.

The panel hopes to issue the report by mid-July.

Bush created the commission March 6 to devise recommendations following reports of shoddy outpatient treatment at Walter Reed Army Medical Center.

But Congress is already moving forward with its own efforts to improve care. A bill passed earlier this month by the Senate Armed Services Committee would make sweeping changes to improve the VA and Pentagon, boosting family services as well as how disability pay is decided and doled out.

The full Senate was expected to consider the measure sometime in July.

The commission's survey, conducted by telephone over the last two months, queried 1,730 injured service members on their experience in getting care, family support, going through the disability ratings system, and what they were doing now.

From their three months of investigation and site visits to medical facilities, it has extensive anecdotes of short-staffing and overwhelmed facilities. Commission staff are now crunching numbers regarding the final statistical outcome, Shalala said.

Earlier in the hearing, congressional leaders urged commission members to embrace bold solutions and utilize their sway with Bush to finally push through changes after years of delay. Lawmakers were open to adding amendments to their bill that would incorporate the commission's recommendations, they said.

"You can give a major push legislatively, but still encounter resistance within the agencies," said Sen. Carl Levin, D-Mich., chair of the Armed Services Committee. "It has to be hammered home."

Rep. Steve Buyer of Indiana, the top Republican on the House Veterans Affairs Committee, was more blunt as to who was to blame.

"We do not need legislation to do the right thing for our service members - we need leaders in the executive branch to take charge of their bureaucrats," he said. "I was heartened when the president formed this commission. ... I remain hopeful, even confident, that your work will take advantage of that support."

Shalala said the final report will take into account Senate legislation but will otherwise seek to be concise and understandable to the everyday reader with about a dozen or so pointed recommendations.

Past reports as long as 10 years ago have long cited problems of poor Pentagon and VA coordination, but may have been ignored or lost in the shuffle partly due to length and their complexity, she said.

In particular, many of the commissioners expressed a desire to strengthen or add provisions that would ensure that families could have free access to private medical care if no adequate government facility is available in their cities.

Currently, injured service members are restricted under Pentagon and VA rules on their choice of facilities, at times forcing them to travel hundreds of miles away for treatment and imposing burdens on family members who must give up their full-time jobs and personal lives to help care for their loved ones.

"Our charge has and will be to focus on solutions that can be activated in a reasonable time," Dole and Shalala said in a joint statement. "We are solution-driven. We will not be issuing a report that points fingers."

Copyright 2007 Associated Press. All rights reserved. This material may not be published broadcast, rewritten, or redistributed

From another source comes a simila
About 1.8M Veterans Are Uninsured, Lack Access To VA Hospitals, Study Finds
Main Category: Health Insurance / Medical Insurance News
Article Date: 25 Jun 2007 - 2:00 PDT
| email to a friend | printer friendly | view or write opinions |

• Public Health

digg_url = 'http://www.medicalnewstoday.com/medicalnews.php?newsid=74981'; digg_title = 'About+1.8M+Veterans+Are+Uninsured%2C+Lack+Access+To+VA+Hospitals%2C+Study+Finds'; digg_bodytext = '%0ALawmakers+on+Wednesday+at+a+hearing+of+the+%3Ca+href%3D%22http%3A%2F%2Fveterans.house.gov%2F%22+target%3D%22_new%22%3EHouse+Committee+on+Veterans%27+Affairs%3C%2Fa%3E+discussed+a+proposal+to+lift+a+ban+on+%3Ca+href%3D%22http%3A%2F%2Fwww.va.gov%2F%22+target%3D%22_new%22%3EDepartment+of+Veterans+Affairs%3C%2Fa%3E+health+benefits+for+higher-income+veterans+w'; digg_topic = 'health';
rate this article



Lawmakers on Wednesday at a hearing of the House Committee on Veterans' Affairs discussed a proposal to lift a ban on Department of Veterans Affairs health benefits for higher-income veterans who have no service-related disabilities in response to a study that found 1.8 million veterans younger than age 65 lack health insurance or access to care at VA facilities, the Washington Post reports.

The ban applies to Priority 8 veterans -- those who have annual incomes that exceed 80% of the median income where they live and have no service-related disabilities (Lee, Washington Post, 6/21). The Bush administration implemented the ban in 2003 because of a need to maintain VA health benefits for an increased population of veterans (CQ HealthBeat, 6/20).

At the hearing, Stephanie Woolhandler of Harvard University presented the study, for which researchers examined data from the Current Population Survey administered by the Census Bureau and the National Health Interview Survey administered by HHS. Researchers considered veterans uninsured when they said they lacked health insurance or access to care at VA facilities. The study found that 12.7% of veterans younger than age 65 were uninsured in 2004, the most recent year for which data were available, compared with 9.9% in 2000 (Washington Post, 6/21). In addition, the study found that 26.5% of uninsured veterans failed to obtain necessary health care because of cost issues and that 31% delayed such care because of cost issues (Reichard, CQ HealthBeat, 6/20).

Woolhandler recommended that Priority 8 veterans receive VA health benefits. According to Woolhandler, about half of the 1.8 million uninsured veterans are considered Priority 8, and the remainder might qualify for VA health benefits but lack access to care because they do not live near department facilities (Washington Post, 6/21). Possible Congressional Action
Committee chair Bob Filner (D-Calif.) said that he plans to introduce legislation to lift the ban on VA health benefits for Priority 8 veterans. Filner said, "I think there is sufficient money for category 8. If the committee and if the Congress approves, I think we could move ahead with the resources that we've put in with the budget."

However, Michael Kussman, undersecretary for health at VA, said, "We believe the current restriction on enrollment of new Priority 8 veterans is necessary to maintain the timelines and quality of health care we provide to currently enrolled veterans." In addition, Rep. Steve Buyer (R-Ind.), ranking member of the committee, said that lawmakers should study the potential effects of removal of the ban on demand for care at VA facilities, adding that the proposal "will open the gates and the surge will come in."

Veteran organizations said that Priority 8 veterans are legally entitled to VA health benefits. John Rowan, president of Vietnam Veterans of America, said, "We strongly urge that you truly honor the commitment that we as a nation have made" (CQ HealthBeat, 6/20).

Washington State
In related news, the AP/Spokane Spokesman-Review on Wednesday examined how Sen. Patty Murray (D-Wash.), a member of the Senate Veterans' Affairs Committee, recently sent a letter to VA Secretary Jim Nicholson that asked for information related to reported problems with two psychiatric wards at department hospitals in Seattle and Tacoma, Wash. Murray also recently flew to Seattle to tour the VA hospitals (Johnson, AP/Spokane Spokesman-Review, 6/20).

Broadcast Coverage
Several broadcast programs recently reported or are scheduled to report on issues related to mental health care for veterans. Summaries appear below.

• C-SPAN's "Washington Journal": The program on Wednesday included a discussion with Vice Adm. Donald Arthur, co-chair of the Department of Defense Mental Health Task Force ("Washington Journal," C-SPAN, 6/20). Video of the segment is available online.
• KCRW's "To the Point": The program on Thursday is scheduled to include a discussion on mental health care for veterans ("To the Point" Web site, 6/22). Additional details about the segment are available online. A broadcast schedule also is available online. Audio of the segment will be available on the program's Web site after the broadcast.
• WBUR's "Here & Now": The program on Tuesday included a discussion with Mark Kaplan, a professor of community health at Portland State University and lead author of a recent study that examined the suicide rate among veterans. The program also included a discussion with Barbara Romberg, a clinical psychologist in Washington, D.C., who provides care to veterans at no cost ("Here & Now," WBUR, 6/19). Audio of the segments is available online.

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.r article:

Senators dispute hybrid benefits, Priority 8

By Rick Maze - Staff writer
Posted : Wednesday Jun 27, 2007 18:20:12 EDT An unusually contentious Senate Veterans’ Affairs Committee meeting Wednesday featured a fight over the creation of hybrid benefits — partly guaranteed and partly set by the whims of the federal budget — plus a battle over priorities for treatment of veterans’ hospitals and even a mention of socialite Paris Hilton.

It was Sen. Bernard Sanders, the political independent from Vermont and sponsor of the proposed hybrid benefits, who brought up Hilton during debate on veterans’ funding as he and Sen. Larry Craig, R-Idaho, discussed veterans’ health care legislation.

Craig, the committee’s former chairman and now senior Republican, was trying to block Sanders’ amendments to increase veterans’ burial benefits and grants for autos and homes that are equipped for the handicapped. Craig also opposed a committee plan that would restore the right to enroll in the veterans’ health care system to veterans with modest incomes and no service-related disabilities, who are in the lowest priority group for care.

“I am concerned that if we flood the system and don’t fund it, we are in for consequences,” Craig said, warning that quality of care could dip and combat-injured veterans from Iraq and Afghanistan could be “shouldered out of the way.”

Sanders said the VA budget could be increased, and that would take care of everything.

“I was elected to change priorities here in Washington,” Sanders said. “Before I give tax breaks to Paris Hilton’s parents and other millionaires, I want to make certain we take care of our veterans,” he said.

Even Craig smiled at the reference to Hilton, but he was not smiling through most of the hearing.

On a mostly party-line vote, Sanders’ proposal to increase plot allowances, funeral benefits and auto and home grants through supplemental payments passed the committee over Craig’s objections. Sen. John Ensign, R-Nev., voted with Sanders and the committee Democrats for the hybrid benefits.

Under Sanders’ plan, attached to S 1315, the Veterans’ Benefits Enhancement Act of 2007, eligible veterans or their survivors would continue to receive current payments — up to $300 for buying a burial plot, up to $2,000 for funeral expenses, and grants of up to $11,000 for adapted vehicles and $50,000 for adapted housing — but could get more than twice as much if Congress pays for supplemental benefits.

His plan would create a supplemental $445 burial plot allowance, up to $2,100 more for funeral expenses and an additional $11,000 for an auto grant and $10,500 for a housing grant.

Sanders said he was creating supplemental benefits rather than increasing existing benefits to try to get around internal budget restrictions used in Congress that require increases in mandatory benefits to be offset by cuts in existing benefits, tax increases or a combination of the two.

Craig said the idea is fraught with problems. First, he said that while he supports some of the ideas, particularly an increase in the burial plot allowance, there is no guarantee any increases would be approved. Second, he said the funding scheme was just a ruse to get around rules that exist to prevent runaway budgets, and that Sanders’ success could start a spending wave if other lawmakers use the same tactic. Third, Craig said it is possible that the supplemental benefits could be paid some years and not paid others, depending on the availability of funding, which would create unfairness.

By a 10-6 vote, the veterans’ committee rejected an attempt by Craig to gut a committee proposal in S 1233, a health care bill that orders the Department of Veterans Affairs to reopen enrollments in the VA for so-called Priority 8 veterans, those with no service-connected disabilities and incomes of at least $27,000 a year.

Four years ago, the VA closed enrollment to this group of veterans, the lowest on the priority list, saying there was not enough money to cover their care. At the urging of Sen. Daniel Akaka, D-Hawaii, the committee chairman, and Sen. Patty Murray, D-Wash., the bill would reopen enrollment for Priority 8 veterans.

The potential effect on the VA of the extra patients is not known. About 17 million veterans could technically qualify, but only about 1.6 million are believed to be really interested in enrolling for VA health care.

Craig noted that 80 percent of Priority 8 veterans have health insurance that would allow them to get care elsewhere. He said their treatment should not come at the expense of other veterans, so he proposed am amendment that would allow enrollment only if the VA certifies that higher-priority veterans would not be hurt and that there is space, people and equipment for the new patients.

“I think opening the system to 17 million new veterans at this time is a bad idea,” Craig said.

But Murray said the VA was “wrong” four years ago to deny care to Priority 8 veterans and that Congress needs to fix the problem, regardless of cost.

“To tell a veteran we may not have enough money to take care of you is the wrong approach,” she said.

Akaka said adding the Priority 8 veterans could end up helping the VA because they will be making co-payments and their private insurance can be billed for care.

“We have fought hard to see that these veterans who have served their country honorably get the care they deserve,” Akaka said.

The committee’s legislation would have to be passed by the full Senate, agreed to by the House and signed by President Bush before it could take effect.

[/list]By JACQUELINE PALANK Published: June 30, 2007 WASHINGTON, June 29 — The presidential commission investigating problems in health care for military personnel wounded in Iraq and Afghanistan held its final hearing Friday, and focused on problems with moving patients through various stages of aid, from Defense Department hospitals to those run by the Veterans Administration or private health care, to home care and to jobs.

Today’s veterans are more likely than those of previous conflicts to suffer from “polytrauma,” including burns, brain injury and shrapnel from explosives, members of the commission said, making their treatment more complicated.

the health care system should also take into account the strain that puts on family members, Comissioners said, and should make more use of contractors who can help in out-patient care.

The commission, led by a Democrat and former secretary of health and human services, and Bob Dole, the Republican presidential nominee in 1996, was established in March after articles in The Washington Post described poor conditions at the Walter Reed Army Medical Center here.

“We’re very solution-driven,” Ms. Shalala said of the panel. “We will not be issuing a report that points fingers.”

Because today’s wounds are different and the families of the veterans are different — many are older, with homes and spouses to return to — more veterans should be allowed to return home for treatment, commissioners said.

Returning patients to their homes can relieve the strain on some families, said commissioners, who reported that some relatives must now leave their homes and jobs to assist with their service members’ treatment in distant hospitals run by the Departments of Defense or Veterans Affairs. But caring for injuries at home requires support from the V.A., they said, and support offered now is often insufficient.

Another consideration is that the patients’ physical wounds are also accompanied by post-traumatic stress[/url] disorder, commissioners said.

The hearing on Friday was the commission’s seventh, and several members of Congress who have introduced legislation on veterans care came to testify. Mr. Dole and Ms. Shalala asked if they would include the commission’s recommendations in pending legislation.

“We would welcome suggestions, absolutely,” said Senator Carl Levin, Democrat of Michigan and chairman of the Senate Armed Services committee.

Mr. Levin said the Senate’s veterans bill, which is scheduled for the floor, seeks to improve medical record sharing between the military and the Department of Veterans Affairs as well as address discrepancies in the disability ratings each department uses to determine how much in benefits a service member is paid each month.

Representative Steve Buyer, Republican of Indiana and the ranking member of the House Veterans’ Affairs Committee, said he was concerned that the departments did not adequately use private contractors to provide outpatient treatment, which could allow patients to receive care at home rather than have to travel to a veterans hospital.

“If we’re patient-centric, we should allow the transition of that patient to occur,” Mr. Buyer said.

Ms. Shalala said, “This is a different war in which we have people who have families and they want to go home.”

Insult to Injury:

War Wounded Underpaid Tom Philpott | June 15, 2007 VA Disability Pay Set too Low for Many War Wounded Disability compensation for veterans severely wounded in Iraq and Afghanistan, particularly the youngest, is set too low, creating a lifetime earnings gap with non-disabled peers, according to a draft study on disabled veterans’ incomes prepared for the Veterans Disability Benefits Commission.

The same study found that disability compensation probably is set too high for veterans who first begin drawing the disability payments at age 65 or older, having already retired from post-service careers.

This imbalance in disability compensation paid by the Department of Veterans Affairs (VA) was a point of contention at a June 8 commission hearing. The data help to explain why younger disabled veterans, facing a lifetime of income challenges, are more dissatisfied with disability pay. But commissioners sounded divided on how to address the imbalance in earning capacity if part of the perceived solution is to dampen future payments to elderly veterans who are awarded VA compensation late in life.

Congress created the commission to examine the appropriateness of benefits being paid to veterans and their survivors. The commission hired the think tank CNA to survey more than 20,000 veterans to determine the effectiveness of VA disability payments in replacing earnings capacity lost to service-connected disabilities when compared to non-disabled peers. The law states restoration of veterans’ average earnings capacity as the primary purpose for VA disability payments.

CNA also examined how well disability compensation meets the “implied intention” of Congress that disability payments also compensate veterans in some way the decline in quality of life from their disabilities.

CNA officials reported this latest commission meeting that they found no evidence basic VA disability payments are set so as to recognize and compensate veterans’ for diminished quality of life as well as earnings loss. The exception is special monthly compensation (SMC) paid to the most severely injured veterans who have lost organs or major bodily functions.

Briefing commissioners on their findings were CNA analysts Joyce McMahon and Eric Christensen. They said current payment levels are “about right” if the goal literally is to compensate an entire population of disabled veterans for lost earnings capacity compared to non-disabled vets.

The typical veteran is awarded disability pay at about age 55. The prevent value of their diminished lifetime earnings is about $150,000 and over their remaining years they will draw about $145,000 in VA disability compensation, nearly matching average earning loss.

But the fairness of disability payments unravels when actual earning losses are broken out by the veteran’s age when payments start, the severity of disability and whether conditions are physical or mental. Earnings capacity is impacted far more dramatically by mental disorders, CNA found.

Other veterans being under compensated, and by a “substantial margin,” said Christensen, are those left 100-percent disabled or unemployable at 45 or younger. McMahon advised commissioners that they might want to consider adjustments to compensation levels, particularly for these younger veterans, given the rising population of wounded returning home from wars in Iraq and Afghanistan.

The analysts noted that when VA compensation fails to keep pace with lost earnings, declines in qualify of life deepen for veterans and their families.

CNA noted that a 25-year-old veteran who returned from war 100-percent disabled from physical wounds and was rated as unemployable by the VA, began receiving $28,352 a year in disability compensation, using 2005 rates. That amount was more than $11,000 short of the $39,447 needed annually to stay even with non-disabled peers, the study found.

VA paid the same $28,352 to a 65-year-old veteran rated as “IU” or individual unemployable. But if that older veteran became disabled for the first time at 65 based on latent service-connected conditions, after working a full career, VA actually is over compensating him, the study found. That’s because that older veteran, with his working life behind him, would need only $10,223 to close an earnings gap with peers who non-disabled veterans.

“So, while on average [VA compensation is] about right, there are age groups for which it over or under compensates,” said Christensen.

The imbalance occurs in part because the disability compensation system takes no notice of age or work experience when payments begin.

The earnings gap is more pronounced for veterans who suffer mental disorders such as post-traumatic stress, CNA reports. A 25-year-old veteran rated 20 to 40 percent disabled from PTSD received on average VA disability compensation $4629 in 2005. Yet to match the earnings of non-disabled veterans of the same age, that PTSD veteran would need almost $11,500 a year in VA compensation for the rest of his or her life, the study found.

By contrast, the 65-year-old veteran newly diagnosed with PTSD, also rated 20 to 40 percent disabling, faces a smaller earnings gap with peers -- only $4070. It’s a gap fully closed by that VA compensation of $4629.

While some commissioners expressed satisfaction that “average” VA compensation was adequate, and others challenged the notion of elderly veterans being over compensated, Commissioner Dennis V. McGinn, a retired Navy vice admiral, said something must be done to raise compensation younger veterans. Commissioner John Holland Grady, an economist, agreed.

“I think we should be zealous in trying to fix that,” said Grady. “I mean the average is interesting but so what?”

CNA analyst McMahon noted helpfully that “whether you are happy with an average depends on which end of the distribution you are on.”

To comment, e-mail milupdate@aol.com, write to Military Update, P.O. Box 231111, Centreville, VA, 20120-1111 or visit: www.militaryupdate.com