Democratic senators and a veterans' advocacy group have urged Republican senators to protect veterans' access to healthcare in their Obamacare replacement bill over fears the House-passed proposal could be particularly dangerous for veterans.
As the Senate creates its own version of the American Health Care Act, advocates claim the U.S. House of Representatives' version hurts veterans by barring veterans eligible for care from the Veterans Affairs Department from receiving tax credits to buy insurance on the individual markets, reducing federal support for Medicaid and effectively ending Medicaid expansion.
The Paralyzed Veterans of America publicly opposed the AHCA on Tuesday. The group's lobbyists have not met with senators since the bill went to that chamber.
The group is particularly concerned about the end of 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.
"If they're non-service connected, they're not going to have access to a state veterans' home," said Susan Prokop, senior associate advocacy director at Paralyzed Veterans of America.
The enhanced federal match was part of the Affordable Care Act.
If federal support for Medicaid is curtailed either through block grants or a per-capita formula, "which can always be ratcheted down," Prokop said, the Paralyzed Veterans of America believes states will restrict how many people can get long-term care, which is very expensive, and accounted for more than 21% of all Medicaid spending in fiscal 2015.
Sen. Richard Blumenthal (D-Conn.) held a news conference with two other senators Tuesday in an effort to draw attention to the carve-out of veterans from exchange tax credits. The problem is that not all veterans can enroll in the VA. 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.
Prokop said the first draft of the bill made it clear that veterans had to be enrolled in the VA to be excluded, not merely potentially eligible for enrollment. That language changed before the bill passed, potentially to alleviate problems for the reconciliation process in the Senate, she said.
In order for an Obamacare repeal to pass in the Senate with a majority rather than 60 votes, the bill has to save money for the federal government, and changes to policy cannot be incidental to that goal.
"To be honest, we're not really sure why they did this," Blumenthal said of the change on veterans and tax credits. "Why should they deprive people of this benefit if they're eligible, even if they're not enrolled? 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.
"It's foolish and cruel and a betrayal of our veterans," Blumenthal said.
"This anomaly doesn't have to be," Prokop said. She hopes that senators crafting an ACA replacement do not include it.
However, Rep. Phil Roe (R-Tenn.), who heads the House Veteran 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 news release on May 4.
Neither veterans advocates nor Blumenthal could say how many veterans currently get subsidies to buy plans on the exchanges. A study by the Urban Institute said 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.
The veterans' carve-out has not gotten attention in the media, so Blumenthal and the Paralyzed Veterans of America said they have not been hearing from veterans about the provision.
Blumenthal said calls to his office focus on pre-existing conditions, Medicaid cuts and Planned Parenthood. But he is hearing from veterans who are concerned about those aspects of the bill, even if they wouldn't directly affect them.
John Jones, who said he fought in Vietnam, is not in danger of losing ACA protections because at 77, he's been in Medicare for years. But he said as he follows the news of what's happening in Congress with the AHCA, "I'm dismayed, I'm frustrated, I'm angry. I don't know what to do and I'm not alone."
Jones, a Kansas resident, joined a hashtag campaign on Twitter last week that said: "#Iamapreexistingcondition." Jones said he didn't even realize he had post-traumatic stress disorder until five years ago, when reading about recent veterans of Iraq and Afghanistan made him wonder if his lifelong anxiety and difficulties with authority could be related to what he experienced in Vietnam.
He wrote: "As a vet of Vietnam (causing PTSD) I guess I have a pre-existing disorder which lets the government off the hook. "
Jones is also concerned about cuts to Medicaid proposed in the AHCA.
"The way the AHCA is being structured, Medicaid is being stripped down, made a nonfederal program, sent to the states," he said, at a time when many states are facing budget woes, including his own state, Kansas.
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. He said: "As Americans understand what the impacts would be of these drastic cuts, they will defend Medicaid."
