Questions raised over AHCA’s impact on protections for veterans
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.