Ten percent of the nation’s 12.5 million non-elderly veterans do not have health insurance coverage or use Veterans Administration (VA) health care, according to the 2010 American Community Survey (ACS). The Urban Institute report, which was released by the Robert Wood Johnson Foundation, is the first to provide estimates of a lack of insurance among veterans and their families both nationally and at the state level, and to assess the potential for the Patient Protection and Affordable Care Act (ACA) to reduce these rates. Veterans are less likely be uninsured than the overall population. Uninsured veterans and their families report significantly less access to healthcare than their counterparts with insurance coverage. Forty-one percent of veterans who lack healthcare coverage have untreated medical needs, while nearly 34 percent have put off getting care because of the expense.
The ACA’s coverage provisions have the potential to increase coverage among the U.S. population, including uninsured veterans. An estimated 50 percent of veterans who currently do not have insurance would qualify for expanded Medicaid coverage; another 40 percent have the potential to receive subsidized coverage through health insurance exchanges if they lack access to affordable employer coverage. Not surprisingly states that have made minimal progress in setting up health insurance exchanges have the most uninsured veterans — nearly 40 percent. Success in bringing coverage to uninsured veterans will depend primarily on aggressive ACA implementation and enrollment efforts.
The Veterans Administration (VA) – with more than 1,400 hospitals nationally and nearly 15,000 physicians – covers the majority of veterans, although not all: Eligibility is determined by income, injuries sustained in combat and length of service. Because of the eligibility requirements, 1.3 million veterans and 0.9 million family members have no healthcare coverage.
Uninsured veterans typically are younger than those with coverage and less likely to have been injured in combat. Uninsured veterans tend to have higher unemployment rates, less income and usually are not married — all of which reduce the odds of having private coverage. “Their lower likelihood of being full-time workers and being married likely contribute to their lack of coverage, as these attributes are characterized by lower access to employer-sponsored health insurance,” according to the Urban Institute study.
Writing for the Non-Profit Quarterly, Rick Cohen notes that “Among the states with the worst rates of uninsured veterans, Louisiana, Oregon, and Idaho all top 14 percent, and Montana comes in at a woeful 17.3 percent. This past weekend, the streets of Washington, D.C. were occupied by participants in the Rolling Thunder demonstration, the annual Memorial Day gathering of veterans (and non-veterans) on motorcycles focused on calling the nation’s attention to the POW/MIA issue. The Robert Wood Johnson Foundation report would suggest that, in the U.S., there is an abundance of veterans and their families who are being treated as if MIA when it comes to health insurance.”
According to Dr. Jonathan D. Walker, assistant clinical professor at the Indiana University School of Medicine in Fort Wayne, “A Harvard study estimated that more than 2,200 veterans died in 2008 due to lack of insurance. You may have thought that veterans can automatically be treated at a veterans’ hospital, but this is not the case. Uninsured veterans face a “means test” based on their income. The test determines their priority level for care and how much they have to pay. And if the system doesn’t have enough money, it can stop enrolling veterans if they fail the means test – as happened from 2003 to 2009. But even if the VA were able to fully cover every veteran, it would still leave a lot of veterans without care because they do not live near a VA hospital. And even if they live near a hospital, they still may need to drive far away to get services that aren’t available locally. There are laws that make it illegal for an insurance company to force patients to drive an excessive distance to stay in their network, yet we think nothing of making veterans drive long distances simply to get the care to which they are entitled.”