How will HCR affect the VA?
March 30, 2010 7:10 AM   Subscribe

How will the recent US healthcare reforms affect the VA hospital system? Will vets be more or less likely to seek treatment at the VA? Will the VA see an overall increase or decrease in number of patients treated?

Obviously any answer will be speculation, but I'm hoping for informed speculation at least.
posted by These Premises Are Alarmed to Law & Government (6 answers total)
To be eligible for VA care, vets must be either injured in the line of duty, or below a certain income threshold. Probably, then, the reforms won't affect vets very much. One could speculate that a few vets who might be poor because of medical debt would no longer qualify, but these numbers are likely to be small.
The number of vets eligible for VA care is going up because the country is engaged in two long term wars which are resulting in very relatively high numbers of injuries (which would have been deaths in earlier conflicts). This is likely to be more significant than any marginal effects of healthcare reform on the VA.
posted by cushie at 7:13 AM on March 30, 2010

Regarding the vets who qualify because of income threshold - if they are now mandated to purchase insurance, will this change where they go for care? (I recognize the economic and social factors can be complicated.)
posted by These Premises Are Alarmed at 7:28 AM on March 30, 2010

They are not mandated to purchase insurance, they are mandated to be insured- so they are covered by the VA (as far as I understand). Many of these people would already also be eligible for Medicaid but opt for VA care instead.
posted by cushie at 7:33 AM on March 30, 2010

Thank you, I was missing that distinction.
posted by These Premises Are Alarmed at 7:38 AM on March 30, 2010

This is made more complicated by the fact that many military service members and their families are eligible for TRICARE, which while not the same thing as the VA hospital system, will understandably have a lot of overlap with patient populations.

TRICARE is not affected directly by the health care bill. Any effect will happen indirectly, as it is likely that this bill will have wide-ranging effects on the American economy at large, e.g. shifting tax strategies, changed employer incentives, etc. But the bill does not touch the operation of TRICARE as such.
posted by valkyryn at 7:43 AM on March 30, 2010

Yes, cushie is right--although VA health benefits aren't, strictly speaking, health insurance, the actual requirement is for individuals to be "covered by acceptable coverage at all times." The bill defines "acceptable coverage" as including certain government programs: Medicare, Medicaid, CHIP, VA benefits, and the benefits provided to Peace Corps volunteers. So any veteran enrolled in the VHA system is satisfying the individual mandate.

However I don't think there is anything in the bill that disqualifies low-income veterans who are enrolled in the VA health system from qualifying for subsidies on the exchanges, which would allow at least some to purchase very low-cost or free private insurance. I'm pretty sure a big chunk of very-low-income veterans will also now qualify for Medicaid where they didn't before, although it's unclear to me if that would be an attractive option. (Having actual insurance, whether Medicare or private insurance, doesn't disqualify one from using VA health benefits. In fact, around 80% of beneficiaries who receive VA health benefits do have other sources of coverage, mostly Medicare.)

There's some evidence that having private insurance reduces the likelihood that a veteran will go to a VHA provider, instead choosing to use the insurance carrier's network of providers. So it's possible that the new bill will reduce the demand for VHA services, holding the population eligible for VA services constant. On the other hand, if all the people newly-insured as of January 1, 2014 unleash a flood of pent-up demand on the existing private system of doctors and hospitals, it might be that veterans find it easier to use the VHA provider system instead--shorter wait times, etc.

Hard to say what will happen, really, other than veterans will almost certainly be better-off, since anybody with current access to VA health benefits won't get whacked by the mandate but might have the opportunity to get better, subsidized coverage through Medicaid or the new exchanges.
posted by iminurmefi at 9:14 AM on March 30, 2010

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