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1 1 (September 15, 2020)

handle is hein.crs/govdbvc0001 and id is 1 raw text is: 0.;0 - riE-SE--$rh .' FF . ' .,i .qi:. i)... 6 i.C .- ¢t Updated September 15, 2020 Do Veterans Have Choices in How They Access Health Care? On June 6, 2018, the President signed into law the VA MISSION Act of 2018 (P.L. 115-182, as amended). Among other things, the act established a new Veterans Community Care Program (VCCP). Under VCCP, all veteran enrollees would be eligible for hospital care, medical services, and extended care services, in the community, provided they meet one of the six criteria stipulated in the law (38 U.S.C. §1703 and 38 C.F.R.§17.4000), at the Department of Veterans Affairs (VA), Veterans Health Administration's (VHA) expense. Because of these policies, the VA expects enrollees to get more of their care through VHA rather than relying on other federal and private health care sources (2021 Congressional Budget Submission, vol. II, p. VHA- 268, and Economic Regulatory Impact Analysis for Veterans Community Care Program, p. 9). Therefore, it is important to understand how veterans currently receive care from the VHA and other sources of health care, such as Medicare and private insurance. 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 (38 U.S.C. §§1703; 1720; 1725; 1725A; 1728). 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, vol. 36, issue 4, winter 2008, p. 680). veerm ,t of 'Pockekt Co*'s- Some veterans are charged copayments based on their priority categories. VA is required (38 U.S.C. §1705) to manage an enrollment system with eight priority categories, with Priority Category 1 being the highest priority for enrollment. Generally, veterans who have been rated with a service-connected disability of 50% or more (Priority Category 1) do not pay any copays for both service- connected and nonservice-connected care. Veterans in Priority Categories 1 through 5 are not required to pay inpatient or outpatient copayments. Nonservice-connected care veterans (who are required to pay) have a copayment for primary and specialty care visits. In addition, for outpatient medications for nonservice-connected care, there is a tiered pharmacy copayments methodology (see CRS Report R42747, Health Care for Veterans: Answers to Frequently Asked Questions). According to VHA, the average annual out-of-pocket costs for veterans receiving care through VHA across all priority categories with co- pays (for outpatient, inpatient, medication, long-term care, and community care) was $279.94 in FY2019, and ranged from $155.28 for Priority Category 2 veterans to $367.84 for Priority Category 8 veterans. N~tern itOthv H ealkh t2vrap Veterans can have multiple forms of health care coverage (i.e., veterans with Medicare may also be covered by Medicaid). According to an analysis done by VHA of the American Community Survey (ACS) data for 2018, of the approximately 17.96 million veterans identified, approximately 9.34 million reported having coverage through Medicare, about 6.61 million had care through the VHA, about 4.04 million had coverage through private health insurance plans (includes those covered by the Indian Health Service), and about 3.31 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). Approximately 510,000 veterans did not have health insurance coverage (see Figure 1). Figure I. Sources of Health Coverage Among U.S. Veterans VA 66 6,OGO, dvate 4,'40,b0 POD/Ti FCAF , sJIuO .................... AMeica d ommuniiiiiiiiitySre (A,,C)daa Notes: Totals do not add up to 17.96 million because a veteran may have more than one kind of coverage. Persons covered by two or p\w -- , gnom goo mppm qq\ , q I 'S 11LIANJILiN,

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