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1 1 (June 28, 2023)

handle is hein.crs/govemby0001 and id is 1 raw text is: Congressional Research Service Informing Kh leis1911ve d bate sice 1914 Introduction to Veterans Health Care Updated June 28, 2023 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. Mssion of the VA Health Care System 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. It also provides health care to some family members through the Civilian Health Medical Program of the Department of Veterans Affairs (CHAMPVA). The VHA is statutorily required to conduct medical research, to train health care professionals, to serve as a contingency backup to the Department of Defense medical system during a national security emergency, to provide support to the National Disaster Medical System (NDMS), and to provide assistance to the federal emergency response efforts (also known as VHA's Fourth Mission), 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. Eligibility for VA health care has evolved over time, and laws governing eligibility have been amended by Congress many times-ultimately creating two broad categories of eligibility. Two significant laws that have affected eligibility include the Health Care Eligibility Reform Act of 1996 (P.L. 104-262) and the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 (PACT Act; P.L. 117- 168). The PACT Act, among other things, made several changes to veterans' health care eligibility for veterans exposed to burn pits or other toxic substances during their military service (see CRS Report R47542, Honoring Our PACT Act of 2022 (P.L. 117-168): Expansion of Health Care Eligibility and Toxic Exposure Screenings). The first eligibility category includes veterans who shall be furnished care. This category comprises veterans with service-connected disabilities; Medal of Honor recipients; Purple Heart recipients; former prisoners of war; World War II veterans; veterans exposed to toxic substances and environmental hazards, including burn pits; and veterans whose attributable income is not greater than an amount established by a means test. The second eligibility category includes veterans who may be eligible to receive care through VA to the extent resources permit. Once veterans are determined to be eligible for care in VHA, most eligible veterans are required to formally enroll in VA's health care system to receive services (38 U.S.C. § 1705). 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 groups. Veterans in some priority enrollment groups 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, coinsurance, and co-payments. Trends in Enrollment P.L. 104-262 required VHA to establish a patient enrollment system. Before the law was passed, VA medical centers used different methods to provide care to eligible veterans based on available resources. VHA started enrolling veterans in FY1999. Figure 1 shows the trends in enrollment and the number of unique veteran patients from FY2000 to FY2024. In FY2000, the total veteran population was 26.75 million, 4.94 million veterans were enrolled in the VA health care system, and 3.46 million unique veteran patients received care. In FY2024, it is estimated that the total veteran population would be 17.91 million, an estimated 9.05 million would be enrolled, and an estimated 6.38 million veteran patients would receive care. 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 I. Veteran Population, VA Enrollees, and VA Patients, FY2000-FY2024 30m FY00 F02 FY04 FY00 FYO8 F 0 FY12 FY14 FY1 6 FY FY20 F'22 FY24 Source: Chart prepared by CRS based on numbers VA budget justifications. Note: FY2024 total veteran population projected as of September 30, 2022. FY2023 and FY2024 veteran enrollee and patient data are estimates.

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