Democrats Call for Gradual Expansion of VA Health System

Some Democratic lawmakers support a policy shift that would gradually allow middle- and higher-income veterans into the Department of Veterans Affairs health care system, CQ Today reports. Since 2003, so-called "Priority 8 veterans" -- veterans who were not disabled during their service and who have incomes greater than $27,790 -- cannot enroll in the VA health system. The income threshold is higher for veterans with dependents and for those living in areas with a high cost of living. The policy was put in place by then-VA Secretary Anthony Principi in an effort to reduce waiting lists and costs. Democratic lawmakers called for the enrollment of Priority 8 veterans in their "views and estimates" of President Bush's fiscal year 2009 budget request, but "it appears that some lawmakers have moderated their views," according to CQ Today.

Senate Veterans' Affairs Committee Chair Daniel Akaka (D-Hawaii) this week is circulating a letter that calls for changes to the income threshold but does not call for admitting Priority 8 veterans into the health system. According to the letter, which will be sent to VA Secretary James Peake, enrolling some Priority 8 veterans in the VA system could generate additional revenue for VA because many middle-income veterans have private insurance. In addition, Priority 8 veterans would have to contribute copayments for VA care.

During a Feb. 13 hearing, Peake was "noncommittal" about increasing the threshold, according to CQ Today. He said the VA's priority "is appropriately for those with service-connected disabilities, those with special needs, and those who really have a significant economic need." The threshold can be altered by Congress or VA. According to VA, if all new Priority 8 veterans were allowed to enroll in the VA health care system, it would cost $3.1 billion in the first year, $16.9 billion over five years and $39.3 billion over 10 years.

House Appropriations Subcommittee on Military Construction, Veterans Affairs and Related Agencies Chair Chet Edwards (D-Texas) last week proposed a plan that would expand VA eligibility and allow some Priority 8 veterans into the system but would not completely lift the ban on Priority 8 enrollment. He said, "My assumption would be, if, overnight, we opened the doors of our VA hospitals to all the Priority 8 veterans, you could end up having such a dramatic increase in demand that you end up compromising quality, increasing waiting lines for doctors' appointments for millions of veterans, including those presently using the system" (Yoest, CQ Today, 3/11).

Shalala
Former HHS Secretary Donna Shalala on Monday said Bush is making progress in improving veterans' care at Walter Reed Army Medical Center, but Congress has stalled on other recommendations, the Raleigh News & Observer reports (Price, Raleigh News & Observer, 3/11). Bush in March 2007 named former Sen. Bob Dole (R-Kan.), a disabled veteran of World War II, and University of Miami President Shalala as co-chairs of a nine-member presidential commission charged with making recommendations to improve military and veterans' health care. Bush formed the group after the Washington Post published a two-part series that examined problems with the conditions at Walter Reed and the process by which injured veterans seek disability compensation (Kaiser Daily Health Policy Report, 7/26/07).

Shalala, in a speech at North Carolina University, said most of the commission's recommendations could be implemented through executive order, and about 10% require congressional approval. However, the election year is distracting Congress from acting on the recommendations, Shalala said (Raleigh News & Observer, 3/11).