Cold War Veterans Blog

With Shrug at CBO, VA Enrollment Expands

Tom Philpott | January 08, 2009

VA Health Enrollment to Rise; Lawmakers Shrug Off CBO

An estimated 258,000 middle-income veterans with no service-connected health conditions will be allowed by late June to enroll in the VA health care system. Enrollment means access to VA health care in exchange for modest co-payments, and also valuable discounts on prescription drugs.

The Department of Veterans Affairs unveiled its schedule for reopening VA healthcare to a quarter million new "Priority Group 8" veterans Jan. 5 -- ironically as President-elect Obama warned of trillion-dollar-year budget deficits and a new report of cost-cutting health care options by the Congressional Budget Office included ideas for tightening access to VA care.

In expanding enrollment, VA is acting at the direction of Congress. Last year, Rep. Chet Edwards (D-Texas) fought successfully to add $350 million to the VA budget so income thresholds that bar Priority 8 veterans could be raised 10 percent to allow more middle income veterans access.

Phillip Matkovsky, deputy chief business officer for the Veterans Health Administration, said veterans with 2008 incomes "10 percent or less" above current Priority 8 thresholds will be able to enroll in VA health care when revised regulations take effect sometime before June 30. The new income thresholds will range from $32,342 for an unmarried veteran and adding $2,222 for each dependent. Geographic income ceilings also will rise.

Veterans who applied for VA enrollment on or after Jan. 1 this year, and were rejected as Priority 8 veterans, need not reapply. Their applications, which already show their 2008 incomes, will be reconsidered and, if they fall under new higher thresholds, enrollment will be approved.

Applicants denied enrollment for having Priority 8 income before 2009 will have to reapply because VA needs to see income information for 2008.

More details on enrollment eligibility expansion are available online at www.va.gov/healtheligibility or by calling 1-877-222 VETS (8387).

In an interview, Edwards dismissed the CBO cost-cutting ideas aimed at raising veterans' out-of-pocket costs or bouncing two million vets from the VA health system because they suffer from no service-related conditions.

"Some of these don't have the chance of a snowball in hell of being passed by Congress," Edwards said. "CBO was simply doing its job to outline what the options are. But a number of those are dead before arrival."

The CBO director who led work on health care options, Peter R. Orszag, is nominated to be Obama's budget director. But Obama had pledged during his election campaign to "allow all veterans" back into the VA health system. He criticized the Bush administration's decision in 2003 to bar new enrollments by Priority 8 vets, those judged to have adequate incomes and no service-related conditions. Obama said it was unfair that the VA was "picking and choosing" which veterans got VA care.

Edwards predicted that Obama will stand by that pledge. But Edwards also has advised the president-elect to reopen Priority 8 enrollment only gradually. It's a view shared by some major veterans' service organizations.

"If we open the doors too quickly," Edwards said, "we would flood the system, undermine quality of health care and lengthen waiting times for doctor appointments."

Chairmen of the House and Senate veterans' affairs committee echoed Edwards' dismissal of cost-saving actions aimed at wallets of veterans, saying they face stiff resistance from Congress and the new president.

"We can't be raising fees and narrowing access at a time when health care is so necessary," said Rep. Bob Filner (D-Calif.). Sen. Daniel Akaka (D-Hawaii), Senate committee chairman, said he doesn't "anticipate" sufficient support in Congress for CBO options targeting veterans.

All three Democratic lawmakers - Akaka, Filner and Edwards - said Obama is committed to making improvements to quality of life for veterans, service members and their families.

"I know we're facing a lot of budget challenges and people will be asked to sacrifice," Edwards said. "But veterans have already sacrificed enough in service to their country.

But Rep. Steve Buyer (Ind.), ranking Republican on VA committee, said reopening enrollment to Priority 8 veterans doesn't make sense with the VA health system still facing many wartime and modernization challenges.

Buyer said the focus should remain on improving care and access to the "core constituency" Priority Groups 1 through 6, those veterans who either have combat wounds, service-related disabilities or are indigent.

"That's the central mission of the VA. That's the purpose of its being," Buyer said. Priority 7 and 8 veterans should told, "If we have capacity, you're welcome," he said

Buyer said it's telling how he got "blistered" by veterans' service organizations when he first took this position while serving a few years back as committee chairman. Yet Disabled Americans Veterans and other groups now express similar worries about access to care for higher priority veterans.

Democrats in Congress and some "Democratic-led" veteran groups, he said, are giving Obama "wiggle room" from his campaign pledge to open VA care to all veterans on the day he takes office, Buyer said.

Buyer predicted the fiscal crisis and ballooning deficits will have the Obama administration recommending higher VA medical co-payments and fees for lower priority veterans, just as the Bush administration did. He also predicted Obama will be persuaded by his Office of Management and Budget to have VA delay its opening the VA health care to 258,000 new enrollees.

"The challenge we have in this town, in this environment, is to manage expectations. [So] it's reasonable that the implementation timeline will slip," Buyer said. VA officials still plan on eligibility expansion by late June.