VA to stop enrolling wealthier veterans

Published: Friday, January 17, 2003 at 6:01 a.m.
Last Modified: Friday, January 17, 2003 at 12:42 a.m.
WASHINGTON - The Department of Veterans Affairs today will stop enrolling veterans with the highest incomes as it tries to control a surge of veterans attracted to the agency's prescription drug benefits.
The cutoff affects about 164,000 veterans who were expected to enroll this year. The move will allow the VA to reduce a backlog that has 265,000 veterans waiting at least six months to see a primary-care doctor, VA Secretary Anthony Principi said in an interview.
Principi said he hopes to blunt the impact by the fall when the department launches a landmark partnership with Medicare. The new program, a first for VA and the Department of Health and Human Services, would allow elderly veterans in the excluded group to seek treatment at VA hospitals and clinics with Medicare paying the bills.
For now, however, Veterans Affairs will focus on eliminating its backlogs, and higher-income veterans without service-connected disabilities are shut out.
"I felt that we needed to focus our resources on the service-disabled, militarily disabled, the poor and those who come to the VA for specialized services such as spinal cord injury," Principi said. "The demand has outstripped our ability to provide timely care."
The veterans excluded beginning today belong to a category called Priority Group 8, which Congress created last year for veterans without service-connected disabilities and who have higher incomes. These veterans have incomes above a VA threshold, which is $24,644 for a single veteran and $29,576 with one dependent and above an index established by the Department of Housing and Urban Development that varies from place to place.
Veterans in that category who are now enrolled can stay in the VA system.
In New York, N.Y., for example, a veteran with a two-person household income above $40,200 is no longer eligible, based on 2002 HUD figures due for revision next month. In Florida, the HUD limit for a two-person family is $30,800 in Gainesville.
The decision to block higher-income veterans from the VA system rolls back a 1996 decision by Congress to open the VA to all veterans. Principi said the VA has the authority to act without legislation and is reacting to a funding gap.
Sen. Bob Graham of Florida, the ranking Democrat on the Senate Veterans Affairs Committee and a potential candidate for president in 2004, denounced the plan after a meeting with Principi on Thursday, calling it "a set of misguided priorities."
Graham said the president wants a $640 billion tax cut while curbing health care for veterans. He said he doubts the move would help the 44,000 veterans in Florida who have been waiting six months to see a VA doctor.
"Suspending enrollment for additional veterans with non-service connected health problems does nothing to alleviate that backlog," Graham said.
Principi said his decision to cut off enrollment covers 2003, but he left open the possibility of extending that. He expects financial help next year.
President Bush is expected to seek a $1.9 billion increase for VA health care in his 2004 budget proposal next month, which would be a 7.7 percent increase over 2003 levels being debated in the Senate. Principi said that would be the largest percentage increase for any agency in the president's budget.
Sen. Arlen Specter, R-Pa., the incoming chairman of the Senate Veterans Affairs Committee, said he supports a Medicare payment program for the VA system. But he said cutting off enrollment deserves hearings in the Senate and would raise questions about funding levels.
"I'm very concerned about it," he said. Some veterans groups said it seems Principi has little choice. Enrollment has rocketed from 2.9 million in 1996 to 6.8 million now, with 2.4 million of that increase since 1999. Experts attribute much of the explosion to the department's generous prescription drug benefit. Some veterans have signed up out of frustration with health maintenance organizations and Medicare restrictions.
More than half of the growth has come from the higher-income Priority Group 8.
"I think it's a workable situation," said Joseph Violante, legislative director for Disabled American Veterans. "Clearly the concern is to get the backlog down, be able to take a breather from some of the higher-income veterans coming into the system."
It's not clear how many of the affected veterans could get into VA hospitals and clinics through the new Medicare program when it is established. An official at the Centers for Medicare and Medicaid Services said many in that group are expected to be eligible. Principi said details of the new Medicare program are still being decided.
Some lawmakers and administration officials have opposed allowing the VA to charge Medicare, but Prinicipi said the White House and the Department of Health and Human Services support the plan.
Called "VA+Choice Medicare," the program would be similar to current "Medicare+Choice" programs under contracts with private HMOs.
Rick Weidman, director of government relations for the Vietnam Veterans of America, generally praised the plan. He raised questions, however, that he said would plague VA, especially in the area of mental health.
Medicare places strict limits on the amount of mental health care patients can receive. Veterans have high rates of post-traumatic stress disorder and other problems that often are triggered when older veterans retire. VA clinics in popular retirement areas such as Florida and the Carolinas might face a quandary when Medicare limits treatment but patients clearly need more.
"Those in VA+Choice Medicare will not be able to get all of the care that would be clinically indicated, and so it makes it very difficult for the clinicians," Weidman said.

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