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1 1 (October 24, 2019)

handle is hein.crs/govbbnf0001 and id is 1 raw text is: IntrodCongressional Research Service Irfo rmr r the Iegaslaitive debate since 1914 Introduction to Veterans Health Care The federal government's role in providing health care to the nation's veterans can be traced back to World War I. The veterans' health care system was first developed in 1919 with the enactment of P.L. 65-326, which authorized the Public Health Service to provide needed care to veterans injured or sick as a result of military service- having a disability that is incurred or aggravated during active military, naval, or air service (today known as a service-connected disability). In 1924, with the enactment of the World War Veterans Act (P.L. 68-242), veterans with no service-connected disability but who were financially unable to pay for care were also given access to Department of Veterans Affairs (VA) health care, thus creating a safety net mission. Congress has enlarged the scope of VA's health care mission, and it has enacted legislation to create new programs and expand benefits and services. This In Focus briefly outlines the mission, eligibility and enrollment requirements, health care delivery system, and funding for veterans health care. Selected trends in enrollment and budget are provided as well. Mission of the VA Health Care System The VA provides health care and health-related services through the Veterans Health Administration (VHA). VHA's primary mission is to provide health care services to eligible veterans and some family members. The VHA is also statutorily required to conduct medical research, to train health care professionals, to serve as a contingency backup to the Department of Defense (DOD) medical system during a national security emergency, and to provide support to the National Disaster Medical System and the Department of Health and Human Services (HHS) as necessary (38 U.S.C. §§7301-7303; §8111A; §1785). Eligibility and Enrollment for Care Not all veterans are eligible to receive care, and not every eligible veteran is automatically entitled to medical care from the VHA. The system is neither designed nor funded to care for all living veterans (The Journal of Law, Medicine & Ethics, Volume 36, Issue 4, Figure 1, Winter 2008). Eligibility for veterans health care has evolved over time, and laws governing eligibility have been amended by Congress many times. The last major eligibility amendments occurred in 1996 with enactment of the Veterans' Health Care Eligibility Reform Act of 1996 (P.L. 104-262). This law established two broad eligibility categories and required the VHA to manage the provision of hospital care and medical services through a priority enrollment system. The first eligibility category includes veterans with service- connected disabilities, Medal of Honor recipients, Purple Heart recipients, former prisoners of war, veterans exposed to toxic substances and environmental hazards such as Agent Orange, and veterans whose attributable income is Updated October 24, 2019 not greater than an amount established by a means test. Veterans who do not meet any of the criteria in the first category compose the second eligibility category and may be eligible to receive care through the VHA to the extent resources permit. Once veterans are determined to be eligible for care in VHA, most veterans are required to formally enroll in the VHA health care system to receive services. Once a veteran is enrolled, the veteran remains in the system and does not have to reapply for enrollment annually. Veterans are placed in one of eight priority enrollment categories. Veterans in some priority enrollment categories are required to pay co-payments for certain benefits. Enrolled veterans do not pay any premiums, deductibles, or coinsurance for their care. This is in contrast to major medical insurance plans, which typically have premiums, deductibles, and co-payments. Trends in Enrollment As required by the Veterans' Health Care Eligibility Reform Act of 1996, VHA began formally enrolling veterans for the first time in FY1999. As shown in Figure 1, just over 4.9 million veterans (18% of all living veterans) were enrolled in the VHA in FY2000; by FY2019, that number was estimated to have increased to 9.2 million enrollees (48% of all living veterans). This increase is due, in part, to factors such as enrollment of newer veterans from Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND), a larger number of female veterans, and economic conditions, among other factors. Figure I. VHA Enrolled Veterans, FY2000 to FY2019 10 7.5 5 2.5 0 .. 2000 2002 2004 2006 2008 2010 2012 2014 2016 2018 Source: Chart prepared by CRS based on VA enrollee numbers in the Department of Veterans Affairs budget justifications. Note: The FY2019 number is an estimate. In a given year, not all enrolled veterans receive their care from the VA-either because they do not need services or because they have other forms of health coverage, such as Medicare, Medicaid, or private health insurance. Figure 2 shows the percentage of enrollees who used the VHA per year since FY2000. Generally, around two-thirds of https://crsrepo-scongress.go,

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