Ques­tions raised over AHCA’s im­pact on pro­tec­tions for veter­ans

Modern Healthcare - - NEWS - By Mara Lee

As the Af­ford­able Care Act re­peal-and-re­place ef­fort ramps up in the Sen­ate, con­cern is mount­ing that a pro­ce­du­ral move threat­ens cov­er­age for tens of thou­sands of veter­ans.

The orig­i­nal ver­sion of the Amer­i­can Health Care Act gave thou­sands of veter­ans ac­cess to tax cred­its to help off­set the cost of pur­chas­ing cov­er­age on the in­sur­ance ex­changes. Un­der the ACA, veter­ans who were el­i­gi­ble for care through the Veter­ans Af­fairs Depart­ment, but not en­rolled, could take ad­van­tage of the tax credit. The re­vised AHCA that passed the House is silent on whether those veter­ans will be able to get the tax credit.

The Sen­ate is mov­ing health re­form through the bud­get rec­on­cil­i­a­tion process, which means pas­sage only re­quires a sim­ple ma­jor­ity, rather than the 60 needed to halt a fil­i­buster. That process comes with some re­stric­tions. In this case, the tax pro­vi­sion has been con­sid­ered out­side the pa­ram­e­ters of the rec­on­cil­i­a­tion process.

Demo­cratic sen­a­tors and a veter­ans’ ad­vo­cacy group also worry that end­ing Med­i­caid ex­pan­sion, as well as a 6-per­cent­age-point match en­hance­ment for Com­mu­nity First Choice—which pays for home health aides for peo­ple with spinal cord in­juries, de­men­tia, mul­ti­ple scle­ro­sis, amy­otrophic lat­eral scle­ro­sis and more—will ad­versely im­pact veter­ans.

If a vet­eran’s med­i­cal con­cerns aren’t re­lated to mil­i­tary ser­vice, “they’re not go­ing to have ac­cess to a state veter­ans’ home,” said Su­san Prokop, se­nior as­so­ci­ate ad­vo­cacy direc­tor at Par­a­lyzed Veter­ans of Amer­ica.

Cur­tail­ing fed­eral sup­port for Med­i­caid ex­pan­sion could also lead states to re­strict how many peo­ple can get long-term care, Prokop said; such care ac­counted for more than 21% of all Med­i­caid spend­ing in fis­cal 2015.

Sens. Richard Blu­men­thal (D-Conn.), Tammy Duck­worth (D-Ill.), Jon Tester (D-Mont.), and Bill Nel­son (R-Fla.) held a news con­fer­ence last week to draw at­ten­tion to the carve-out of veter­ans from ex­change tax cred­its. The prob­lem is that not all veter­ans qual­ify for VA care. Veter­ans with­out ser­vice-re­lated dis­abil­i­ties who make more than $35,176 in in­come with no de­pen­dents are not el­i­gi­ble for VA health­care. For a vet­eran with two de­pen­dents, earn­ing more than $44,629 makes them in­el­i­gi­ble.

The orig­i­nal ver­sion of the AHCA made it clear veter­ans had to be en­rolled in the VA to be ex­cluded, not merely po­ten­tially el­i­gi­ble for en­roll­ment. That lan­guage changed be­fore the bill passed.

“To be hon­est, we’re not re­ally sure why they did this,” Blu­men­thal said of the change on veter­ans and tax cred­its. “Es­pe­cially since Repub­li­cans are en­cour­ag­ing more and more veter­ans to go out­side the VA.”

Cur­rently, just un­der 6.7 mil­lion veter­ans go to VA fa­cil­i­ties, out of more than 21 mil­lion veter­ans, ac­cord­ing to the Con­gres­sional Re­search Ser­vice. Nei­ther veter­ans ad­vo­cates nor Blu­men­thal could say how many veter­ans get sub­si­dies to buy plans on the ex­changes. An Ur­ban In­sti­tute study found there are 225,000 veter­ans who would be el­i­gi­ble for mar­ket­place sub­si­dies if they did not have em­ployer-based cov­er­age; how­ever, if veter­ans fol­low the over­all pat­tern of pri­vate health­care cov­er­age, only about 29,000 of this pop­u­la­tion would be in the in­di­vid­ual mar­ket.

Rep. Phil Roe (R-Tenn.), who heads the House Veter­ans Af­fairs Com­mit­tee, said ad­vo­cates and Democrats mis­un­der­stand the con­se­quences of the lan­guage change.

“The sim­ple fact is that an at­tempt to make an ex­ist­ing reg­u­la­tion the law of the land was found to be in vi­o­la­tion of the Sen­ate’s rec­on­cil­i­a­tion rules, so that lan­guage had to be re­moved. Noth­ing in this bill would change the ex­ist­ing reg­u­la­tion, and veter­ans’ ac­cess to tax cred­its will not be af­fected by the Amer­i­can Health Care Act,” he said in a May 4 news re­lease. Blu­men­thal said while the pub­lic’s at­ten­tion has been largely on pre-ex­ist­ing con­di­tions, he thinks the changes to Med­i­caid will in­spire vot­ers to act as well. “As Amer­i­cans un­der­stand what the im­pacts would be of these dras­tic cuts, they will de­fend Med­i­caid,” he said.

See pp. 21-24 for ad­di­tional cov­er­age on the health­care re­form de­bate


Sens. Jon Tester, Tammy Duck­worth, Bill Nel­son and Richard Blu­men­thal used a news con­fer­ence to call on the Sen­ate to ad­dress tax is­sues that veter­ans will face in the Amer­i­can Health Care Act.

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