VA CATEGORY 8 CARE UPDATE

 A key lawmaker is urging President-elect Barack Obama to move slowly and cautiously on his pledge to grant all veterans medical attention at Veterans Affairs Department facilities, or else risk clogging they system and harming quality. Obama said repeatedly during the campaign that one of his first acts as president would be to sign an executive order permitting veterans with non-service-related disabilities to seek medical care within the VA system. These so-called “Priority Group 8” veterans make up the lion’s share of living American veterans. Vets are designated as Priority 8 when their income exceeds a pre-set threshold, which varies from county to county based on the level of affluence in a given location. They are the most affluent category of vets, but some earn as little as $28,430 a year. Until 2003, these veterans were permitted to seek treatment at VA health facilities, but the department announced a freeze on new Priority 8 enrollments that year to alleviate a 300,000-plus patient backlog and quell a funding crisis. Chet Edwards, chairman of the House Appropriations Military Construction, Veterans’ Affairs and Related Agencies Subcommittee, says that he will fight to fund VA health care for Priority 8 veterans but that he wishes to do so at a gradual pace. “Even if we had unlimited dollars, it would take time to hire all the doctors and nurses,” said Edwards, D-Texas. “We don’t want to double, triple, quadruple the wait times. I would urge the administration to maintain the goal but spread it out equally.”

         This approach would involve continuing to raise the Priority 8 income threshold over a number of years to gradually include more and more veterans. Congress authorized $375 million in the fiscal 2009 Military Construction and Veterans Affairs spending measure (PL 110-329) to raise the Priority 8 income threshold and bring more of these veterans into health-care-eligible categories. But it is unlikely that the amount appropriated will do much to move the threshold to a significantly higher income level, according to a Senate Veterans’ Affairs Committee aide. So far, the Obama presidential transition team has declined to disclose details on the implementation of his campaign promise, but it is certain to be expensive, however the new administration decides to do it. If Obama orders a plan to gradually raise the threshold to eventually cover all veterans, it would require Congress to continue to increase record funding for the VA year after year. Aides note that if he wants to make all Priority 8 veterans eligible at the same time, it would likely require an emergency supplemental spending bill that would total billions of dollars. With Congress already providing $700 billion to help bail out failing banks and other businesses, the government’s capacity to provide another supplemental spending measure is questionable.

         Obama will have plenty of backers on Capitol Hill for his VA medical coverage plans. Rep. Bob Filner, chairman of the House Veterans’ Affairs Committee, contends that there are actions Congress can take to bring all Priority 8 veterans into the VA health care system at once. For example, the VA currently has an inefficient system for recouping money from private health insurance companies when covered veterans go to the VA for treatment, said Filner (D-CA). Installing more effective tracking technology would reward the VA with billions of dollars, he added. “I have talked to people who have systems to do this, and they are telling me about several billion dollars, easy,” Filner said. “I have seen $3 billion or $4 billion estimated.” Filner also said Medicare should reimburse the department when Medicare-eligible veterans get treatment at the VA. “We are saving them money,” he said. Sen. Patty Murra (D-WA), a potential chairwoman of the Veterans’ Affairs Committee in the 111th Congress and a member of the Military Construction and Veterans’ Affairs Appropriations Subcommittee, is also a strong proponent of giving Priority 8 veterans full VA health care eligibility. “While the VA health care system certainly has its share of problems, closing its doors to thousands of veterans who have served us is not the answer to fixing them,” Murray said. “That means expanding access, but it also means providing the funding and resources to hire doctors and staff, invest in VA infrastructure, do research, and decrease the wait on benefit claims. We make a promise to all veterans when they sign up to serve that, regardless of their future income or health needs, they will receive VA medical care.”

         Like Edwards, veterans’ advocacy groups favor a more gradual approach. Their main concern is that opening up the VA’s health facilities to at least 400,000 new patients could put the VA on the same faulty financial footing that plagued the department before 2003. They also say it is not just a matter of securing funding; they say the VA would need time to put the money to use by hiring new doctors and clinical staffers, building and leasing new facilities, and procuring new equipment. “If he just opens the gates wide open and says everyone is eligible now to enroll for VA health care, then we would find ourselves back in that same situation again,” said Joseph Violante, national legislative director for Disabled American Veterans. "While the VA has gotten nice budgets the last two years, it will not be in a position to care for a large influx of new veterans,” Violante said. “We would wind up getting rationed care for all the veterans that are in the system, including the service-connected disabled.” Rationed care is a large concern at a time when thousands of service members are returning home from Iraq and Afghanistan with severe injuries. “We are concerned that adding more veterans into the system may take away priority for the service-connected wounded, especially the most severe service-connected,” said Bob Wallace, executive director at Veterans of Foreign Wars. “They need to be taken care of before anybody else.” [Source: CQ  Veterans' Affairs Matthew M. Johnson article 18 Nov 08 ++]