About | HeinOnline Law Journal Library | HeinOnline Law Journal Library | HeinOnline
LOG IN
LOG IN

1 1 (June 13, 2016)

handle is hein.crs/govcdyv0001 and id is 1 raw text is: 01;0i E~$~ & June 13, 2016 Do Veterans Have Choices in How They Access Health Care? Following the challenges encountered in the implementation of the temporary Veterans Choice Program (VCP) established by the Veterans Access, Choice and Accountability Act of 2014 (P.L. 113-146, as amended), Congress required (P.L. 114-41) the Department of Veterans Affairs (VA), Veterans Health Administration (VHA), to submit a plan to consolidate and streamline the numerous programs that authorize care for veterans in the community (non-VA care). The plan (http://tinyurl.com/nmyyorn) was submitted to Congress on October 30, 2015 (http://tinyurl.com/o9nq5s6). Currently, Congress is discussing various proposals (among them S. 2633, S. 2646, and some provisions in S. 2921) to consolidate and/or streamline various community care programs and establish one unified VCP. As Congress debates the future state of VA care, it is essential to understand how veterans currently receive care from the VHA and other federal and private health care sources. Compared with the predominant health care delivery model in the United States-where there is a payer (e.g., Medicare or private health insurance), a provider (e.g., hospital, physician), and a recipient of care (the patient)-the VA is a very different model of care. In general, private health insurance plans charge premiums from beneficiaries for enrolling in those plans. Furthermore, most private health insurance plans have cost-sharing requirements (that is the amount that beneficiaries are required to pay out of pocket when they use health care services). These could include deductibles (the amount a beneficiary must pay out of pocket before the insurance plan begins paying for services), coinsurance (a specified percentage a beneficiary pays out of pocket to providers after meeting any deductible requirements), or copayments (a fixed amount paid for a health care service, at the time of service). In contrast, VA is primarily a direct provider of care funded through annual discretionary appropriations-although VHA does pay for care in the community under certain circumstances. In addition, in the VHA system, enrolled veterans do not pay any premiums, deductibles or coinsurance. Furthermore, generally not all veterans are eligible to enroll in the VA health care system-the system is neither designed nor funded to care for all living veterans (The Journal of Law, Medicine & Ethics, Volume 36, Issue 4, p.680, Winter 2008). vctcrams Out of P>kctCoz Some veterans are required to pay copayments for medical services and outpatient medications related to the treatment of a nonservice-connected condition (see CRS Report R42747, Health Care for Veterans: Answers to Frequently Asked Questions). Generally, veterans who have been rated with a service-connected disability of 50% or more (Priority Group 1) do not pay any copays for both service-connected and nonservice-connected care. Other groups of veterans, such as veterans who are considered to be catastrophically disabled (Priority Group 4), are also exempt from outpatient, inpatient, and prescription copays. Nonservice- connected care veterans (who are required to pay) pay a copayment of $15 per primary care visit, $50 per specialty care visit, and up to $97 per day for care in a veterans long- term care facility. In addition, for outpatient medications for nonservice-connected care, some veterans are charged $8 for a 30-day supply, whereas others are charged $9. According to VHA, the average annual out-of-pocket costs for veterans receiving care through VHA across all priority groups with co-pays (for outpatient, inpatient, medication, and long-term care) were $325.66 in FY2015, and ranged from $203.26 for Priority Group 2 veterans to $402.69 for Priority Group 8 veterans. Based on the Independent Assessment (http://tinyurl.com/ gsyzgyd) of the VA health care system-conducted by the Centers of Medicare and Medicaid Alliance for Modernizing Health, operated by MITRE Corporation-a majority of veterans enrolled in VHA have access to other health care coverage (Assessment A, p. 65). According to a separate analysis done by VHA of the American Community Survey (ACS) data for 2014, of the approximately 22.5 million veterans identified, approximately 11.3 million reported having coverage through Medicare, about 6.4 million had care through the VHA, and about 3.3 million veterans had care through the Department of Defense (DOD) TRICARE program (TRICARE and TRICARE for Life-veterans are eligible for TRICARE if they served for at least 20 years in the military; veterans are eligible for TRICARE for Life if they qualify for Medicare and it is available as a wraparound coverage for costs not covered by Medicare). According to the ACS survey data analyzed by VHA, approximately 980,000 veterans did not have health insurance coverage (see Figure 1). Figure I. Sources of Health Coverage Among U.S. Veterans , , .. .. ..... ..... ::::::::::: . ,.. .. .. .. Source: Figure adapted by CRS based on VHA analysis of 2014 American Community Survey (ACS) data. 'O rq\\ 's - - ' gn'a', 'S a X 11LULANJILiN,

What Is HeinOnline?

HeinOnline is a subscription-based resource containing thousands of academic and legal journals from inception; complete coverage of government documents such as U.S. Statutes at Large, U.S. Code, Federal Register, Code of Federal Regulations, U.S. Reports, and much more. Documents are image-based, fully searchable PDFs with the authority of print combined with the accessibility of a user-friendly and powerful database. For more information, request a quote or trial for your organization below.



Short-term subscription options include 24 hours, 48 hours, or 1 week to HeinOnline.

Purchase Access

Contact us for annual subscription options:

Contact Us

Already a HeinOnline Subscriber?

Log In

profiles profiles most