B. Allen Bradford
How will military Veterans be affected by the Republican/Trump administration efforts to repeal and replace key parts of the ACA? To understand that, we must first understand how Veterans were affected by ACA/Obamacare in the first place.
ObamaCare and Vets
The “Obamacare” or private insurance and Medicaid features of the Patient Protection and Affordable Care Act (“PPACA”) had little direct effect on veterans’ health coverage. In fact, Veterans Administration (“VA”) Health Plans meet the PPACA’s individual mandate requirement. And PPACA did not change benefits available under VA Health Plans, or the out of pocket (copayment, coinsurance) costs.
But the VA system is not accessible everywhere. Longer wait times at some VA facilities remain a problem. Also, as reported by the Washington Post, “Veterans are not automatically eligible for Veterans Health Administration benefits. Instead, enrollment depends on meeting certain requirements, for instance, serving 24 continuous months. Priority and access to doctors depends further on other characteristics like service-related disabilities and income.”
As a result, veterans benefited just as others did from PPACA provisions expanding Medicaid, providing subsidies for individual coverage and mandating employer coverage. According to an Urban Institute study summarized by CNN, “The uninsured rate among veterans under age 65 dropped to 5.9% in 2015, down from 9.6% two years earlier…. The number of vets lacking coverage fell to 552,000, down from 980,000. The changes started in 2014, when … Medicaid expansion took effect and the Obamacare exchanges opened. Most uninsured veterans had incomes that would make them eligible either for Obamacare subsidies or Medicaid.”
Many veterans have also benefited because Obamacare does not allow insurance plans to deny coverage for people with pre-existing conditions, or deny coverage for the pre-existing condition itself, or charge higher premiums for such a pre-existing condition. So a veteran with a combat related injury need no longer fear that the insurance company would deny coverage, putting him/her back into a potentially long wait at a VA facility, assuming one was available.
Finally, the PPACA required insurance companies to cover mental health services. Per a Rand Corporation study, “about one-third of returning Service members report symptoms of a mental health or cognitive condition,” so this PPACA mandate has surely benefited many veterans.
Impact of the Republican Bills on Veterans’ Care
In May, the House of Representatives by a narrow margin approved the “American Health Care Act,” which would repeal and replace certain Obamacare provisions of the PPACA. A couple of weeks ago, Republicans in the Senate rolled out their own ObamaCare repeal and replace effort, the “Better Care Reconciliation Act,” a newer version of which is being introduced this week. The fate of both bills is currently uncertain. Just as with the original PPACA, while neither the bill directly addresses health coverage for Veterans, both would have an effect.
I’ve addressed the House bill and its impact on preexisting conditions in earlier blogs. But for purposes of this blog, here are some key points:
The Senate bill differs from the above House bill in some important points:
A comparison of key provisions of the PPACA and House and Senate bills is available here: NPR Health Shots.
If the PPACA is repealed, then those veterans who lose commercial or Medicaid coverage, or coverage for their particular conditions, may have to turn back to the VA system, which, while certainly a viable option, remains overburdened. NPR Reports that “a health policy researcher at the Rand Corp. says 3 million vets who are enrolled in the VA usually get their health care elsewhere — from their employer, or maybe from Obamacare exchange. If those options go away… ‘I would expect that the number of veterans using VA health care will increase, which will only provide a further challenge for VA to provide timely and accessible care’.”
Such concerns may explain why at least some Veterans groups are opposed to the PPACA repeal bills, although opposition is certainly not monolithic.
B. Allen Bradford is a senior member and co-founder of Bradford, Perlstein & Associates, LLC, and is “of counsel” with James, James & Joyner. Most of his clients are emerging and entrepreneurial businesses, health care providers and other professionals. He writes this occasional column primarily to demystify the intersection of legal and health issues for individual consumers, physicians and small businesses. However, nothing herein is intended as legal advice. You can follow him on Twitter at: @LegalHealth.