The Department of Veterans Affairs is advocating legislation that would cut off some healthcare benefits to veterans who contract smoking-related illnesses.
The legislation would reverse a 1993 declaration by the VA general counsel's office that said the government could be held responsible for disabling illnesses that occur from veterans' use of tobacco while in the armed services.
The VA's legislation, however, would permit veterans to seek coverage for smoking-related illnesses that arise while they are in the service or for a limited period afterward. The legislation has not been introduced in Congress.
The department also is asking Kenneth Kizer, M.D., the VA's undersecretary for health, to judge whether nicotine dependency should be considered a disease that should be treated by VA healthcare facilities.
"We do not believe that the government should be held responsible for all the consequences of smoking," said VA spokesman Ken McKinnon.
To be eligible for healthcare in VA facilities, veterans and the VA must determine "what's the connection between the cigarettes you started smoking and the disease you get later," McKinnon said.
One veterans group objected, however, saying the legislation would give the VA an "easy out" from caring for some veterans who may have diseases totally unrelated to smoking.
"Smoking sometimes is a convenient reason for VA to deny (coverage) for respiratory diseases or cancer," said Joe Violante, deputy national legislative director for Disabled American Veterans.
Violante said the government shares some responsibility for smoking-related illnesses because in the past it has included cigarettes in soldiers' rations or offered them at discounts at military-base stores.
Veterans' entitlement or eligibility for all or some of their healthcare needs is determined by whether they have a disease that can be attributed to their time in the service and how much weight the VA gives to the disabilities related to that disease.
Although there are no estimates on how this would affect the VA healthcare system's budget, it will have some effect on demand both at VA healthcare facilities and nearby private providers.
If the VA rejects some veterans' claims for smoking-related illnesses because of the legislation, it's more likely the veterans will be forced to seek care at private providers. And because a large number of the VA's patients are indigent, it has the potential to increase the burden on safety-net hospitals.
In federal fiscal 1996, the VA treated 1.5 million veterans, including 699,000 who were eligible because of low incomes and 594,000 who were eligible because of service-related disabilities.