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Just 8.9 million out of the 22 million veterans in the United States obtain Veterans Administration health benefits, which are reserved for those who have been disabled through military service or are very low-income and overseen by the Department of Veterans Affairs, shown above in a file photo.
Karen Bleier / AFP / Getty Images
Just 8.9 million out of the 22 million veterans in the United States obtain Veterans Administration health benefits, which are reserved for those who have been disabled through military service or are very low-income and overseen by the Department of Veterans Affairs, shown above in a file photo.
Karen Bleier / AFP / Getty Images
Study: Over 1.2 million veterans lack health insurance
Study says vets earned too much for VA benefits; many live in states refusing ACA funding to expand Medicaid
A study published in The Lancet sheds light on a little-discussed issue affecting U.S. military veterans — a lack of health insurance coverage.
Most people assume that veterans automatically receive health care coverage through the Veterans Health Administration, but that’s actually not the case, according to the authors of the study published Sunday, Dr. Dave A. Chokshi of NYU Langone Medical Center and Dr. Benjamin Sommers of the Harvard School of Public Health.
Using numbers from the Census Bureau’s American Community Survey, they determined that more than 1.2 million veterans lacked health insurance in 2012, the latest year for which data is available, in line with previous studies that came to similar conclusions. In fact, just 8.9 million out of the 22 million veterans in the U.S. are enrolled in VA health benefits, which are reserved for those who have been disabled through military service or are very low-income. Other vets tend to obtain insurance on the private market.
The researchers found that most uninsured veterans lived in states that had decided not to accept the Affordable Care Act’s federal funding to expand Medicaid, the government’s insurance program for low-income people.
For example, they determined that there were 126,000 uninsured military veterans living in Texas, 95,000 in Florida, 54,000 in North Carolina and 53,000 in Georgia. None of those states, all with Republican governors, are expanding their Medicaid coverage, programs to cover people living at or below 138 percent of the federal poverty line, or a combined income of just under $33,000 for a four-person household.
But the authors also determined that 87 percent of currently uninsured veterans are probably eligible for coverage through Medicaid expansion, through subsidized plans offered on the ACA’s insurance marketplaces or through the VA.
“With the introduction of the ACA, universal coverage for veterans could be an achievable goal, albeit one that requires renewed commitment and policy attention,” the authors wrote.
“To call for expanded coverage might seem ill-timed when the VA health system is struggling to keep pace with demand. Yet, paradoxically, the present crisis could provide an opportunity to address these related access problems,” they said.
While the number of uninsured Americans has decreased by 26 percent by the close of the first-open enrollment season for the ACA's insurance exchanges, which began in October 2013, the Department of Health and Human Services hasn’t indicated how many veterans were among the 7.1 million people who enrolled in coverage through the marketplaces in that time.
But previous studies have suggested that obtaining health insurance is a problem for veterans. For example, a 2007 study conducted at the VA Puget Sound Health Care System found that many veterans didn’t know they were eligible for VA care. The researchers also said that those vets who did use the VA for all their health care needs tended to be from lower-income, less educated and minority populations.
“So the Affordable Care Act has the potential to address some of the holes for veterans” through Medicaid expansion and the insurance exchanges, she said.
However, Kenney, who co-authored a study about the Medicaid eligibility of uninsured veterans, pointed out that fewer vets have gone without insurance than civilian adults, and that is because of the VA.
“It [the VA] does provide coverage and care to millions of other veterans who don’t have other options,” she said.
Dr. Steffie Woolhandler, a professor of public health at the CUNY School of Public Health at Hunter College, said she began to treat veterans who didn’t have insurance coverage during the decades she spent working as a primary-care physician at the Cambridge Hospital and Massachusetts General Hospital, in Massachusetts. Like most doctors, she assumed they were covered through the VA. “I said, ‘Why don’t we call the VA?’ and they’d say ‘No, no, you’re not eligible,’” she told Al Jazeera.
“They were mostly these lower-income, low- to middle-income working people whose incomes were too high to qualify for [VA-covered health insurance for the poor], but they still couldn’t afford private health insurance,” she said.
Many uninsured veterans reside in states that are not expanding Medicaid
Highlighted states are those that are expanding Medicaid
State
Percentage of veterans uninsured
Estimated veterans uninsured
Expanding Medicaid?
Alabama
4.52%
18,000
No
Alaska
8.32%
6,000
No
Arizona
6.03%
32,000
Yes
Arkansas
8.26%
20,000
Yes
California
4.51%
88,000
Yes
Colorado
7.14%
29,000
Yes
Connecticut
2.19%
5,000
Yes
Delaware
2.61%
2,000
Yes
District of Columbia
3.25%
1,000
Yes
Florida
5.91%
95,000
No
Georgia
7.55%
53,000
No
Hawaii
3.55%
4,000
Yes
Idaho
7.15%
9,000
No
Illinois
5.30%
40,000
Yes
Indiana
7.04%
33,000
Open debate
Iowa
4.71%
11,000
Yes
Kansas
5.03%
11,000
No
Kentucky
5.94%
19,000
Yes
Louisiana
7.35%
23,000
No
Maine
6.12%
8,000
No
Maryland
3.65%
16,000
Yes
Massachusetts
1.75%
7,000
Yes
Michigan
5.34%
37,000
Yes
Minnesota
3.18%
12,000
Yes
Mississippi
8.19%
17,000
No
Missouri
6.67%
33,000
No
Montana
9.18%
9,000
No
Nebraska
4.77%
7,000
No
Nevada
6.97%
16,000
Yes
New Hampshire
4.33%
5,000
Yes
New Jersey
3.71%
17,000
Yes
New Mexico
8.53%
15,000
Yes
New York
3.03%
29,000
Yes
North Carolina
7.31%
54,000
No
North Dakota
5.48%
3,000
Yes
Ohio
5.82%
52,000
Yes
Oklahoma
6.83%
22,000
No
Oregon
6.00%
20,000
Yes
Pennsylvania
3.97%
39,000
Yes
Rhode Island
4.00%
3,000
Yes
South Carolina
7.06%
28,000
No
South Dakota
5.73%
4,000
No
Tennessee
6.28%
31,000
No
Texas
7.82%
126,000
No
Utah
6.14%
9,000
Open debate
Vermont
3.94%
2,000
Yes
Virginia
4.90%
36,000
No
Washington
5.38%
32,000
Yes
West Virginia
6.67%
11,000
Yes
Wisconsin
3.54%
15,000
No
Wyoming
5.86%
3,000
No
National
5.54%
1,217,000
N/A
Sources: The Lancet, 2012 American Community Survey (ACS) five-year estimates Notes: Estimates are based on the authors' analysis of data from the 2012 American Community Survey as of Oct. 26, 2014. The percentages of uninsured were calculated by using the number of veterans in each state, based on the 2012 ACS five-year estimates.
CORRECTION: A previous version of this story incorrectly indicated in the table which states were expanding Medicaid.
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