Reform Update: Saying Medicaid expansion will help some vets is not likely to sway opponents

Congress this week is expected to approve new funding legislation designed to get veterans off Veterans Affairs healthcare waiting lists and into care.

While that moves forward, some patient advocates, hospital leaders and politicians are pointing to another, more controversial way to help a small portion of the veteran population that doesn't qualify for VA health benefits—namely, expansion of Medicaid in current non-expansion states.

While it's assumed that serving in the U.S. armed forces automatically makes a person eligible for veteran health benefits, that's not necessarily the case. A former serviceman may not be eligible if he or she doesn't meet certain criteria related to length of service time, how they were discharged, income or nature of disabilities.

In all, of the 12.5 million U.S. non-elderly U.S. veterans, approximately 1.3 million non-elderly veterans found themselves without coverage because of not qualifying for benefits as of May 2012, according to the Urban Institute. Of those, 258,600 are living below the poverty line in states refusing to expand Medicaid, according to a 2013 estimate by The Pew Charitable Trusts.

The legislation now making its way through Congress will benefit only those who are currently eligible for benefits.

Tom Bell, president and CEO of the Kansas Hospital Association, called for Medicaid expansion in his state in an op-ed last month in the Wichita Eagle. “It's the job of elected state officials, including our governor, to help veterans and their family members gain access to that line,” he wrote.

Kansas has 15,000 veterans and 10,000 family members without health insurance, he said.

Hospitals, in other non-expansions states have similar worries. In Indiana for instance, more than 31,000 Indiana veterans and 15,000 spouses of veterans are uninsured.

“Many of these families are working hard in minimum wage jobs and make too much to qualify for existing assistance programs, but not enough for subsidies through the health insurance marketplace,” said Douglas Leonard, president of the Indiana Hospital Association.

It's not just hospitals who are hoping shining a light on veteran access issues will get state lawmakers in holdout states to change course. Former Florida governor Charlie Crist, a Democrat, has been using the issue as a talking point in his current gubernatorial campaign against opponent Rick Scott, the current Republican governor.

“Scott has put politics ahead of the courageous men and women who have served and are struggling to find health care,” Crist said in outreach materials.

Rep. Ted Deutch (D-Fla.) joined in a call to expand Medicaid in a post on his site last month. “Expanding care to 41,000 veterans through Medicaid expansion would be a game changer for veterans and their families in our state” he said.

It's unlikely the uninsured veteran argument will get many governors and state legislators to change their minds on Medicaid expansion, however.

“This has become such a political fight, that even the most deserving or sympathetic groups have trouble getting heard,” said Adam Searing, senior research fellow at Georgetown's Center for Children and Families.

States have enrolled 6.7 million new Medicaid and Children's Health Insurance Program beneficiaries, from the start of open enrollment in October 2013 until the end of May 2014, according to a report from the Robert Wood Johnson Foundation.

These additional enrollees represent 52% of the projected 12.8 million new Medicaid/CHIP enrollees by 2016. Within states that expanded the program, those operating their own insurance marketplace were more successful in enrolling new Medicaid beneficiaries than states that relied on, or partnered with, the federal government to operate their exchange, according to the report.

The Florida Medical Association's House of Delegates has adopted a resolution supporting Medicaid expansion to cover uninsured low-income adults in the state, with one caveat.

The providers would only support expansion if the state upheld a policy outlined in the Patient Protection and Affordable Care Act that paid them at Medicare rates for services rendered. Federal funding for that section of the law ends at the close of 2014 which means Florida would have to cover the difference. Medicaid tends to pay at 60% of Medicare rates.

Medicaid expansion would help 800,000 Floridians who make too much to qualify for the state's traditional Medicaid program, but too little to qualify for subsidies on the new federal marketplace, according to the association.

Follow Virgil Dickson on Twitter: @MHvdickson