Health & Medicine - Posted by Carole Gan-UC Davis on Tuesday, February 28, 2012 12:22 - 6 Comments 
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(No Ratings Yet) Loading ...Will the Affordable Care Act hurt veterans?
“We need to define and quantify the potential impacts that additional health-insurance choices from the Affordable Care Act will have on the delivery of health-care services for veterans in 2014,” says Kenneth W. Kizer, director of the Institute for Population Health at the UC Davis Health System. (Credit: Shaine Mata / Flickr)
UC DAVIS (US) — An expert says that veterans may suffer unintended negative consequences of the Affordable Care Act.
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The text of this article by Futurity is licensed under a Creative Commons Attribution-No Derivatives License.
The Affordable Care Act will expand health insurance coverage for low-income persons through Medicaid and state health-insurance exchanges, including much-needed care for 1.8 million uninsured veterans in the U.S.
However, the new insurance coverage option may have a number of unintended negative effects on health care for veterans, says Kenneth W. Kizer, director of the Institute for Population Health Improvement at the University of California, Davis.
His viewpoint, including recommendations for evaluating services in preparation for 2014, appears in the Journal of the American Medical Association.
“The Affordable Care Act will not affect health care for the majority of veterans differently than it will affect nonveterans, and it will not change eligibility for VA health care, covered benefits, co-payment for services, or how the VA health-care system is administered or operated,” Kizer says.
“But it will affect health care for many veterans through its effects on access, fragmentation and quality of care, utilization of services, the health-care workforce, and cost.
“We need to define and quantify the potential impacts that additional health-insurance choices from the Affordable Care Act will have on the delivery of health-care services for veterans in 2014.”
A former undersecretary for health in the U.S. Department of Veterans Affairs and a veteran of the U.S. Navy, Kizer engineered the transformation of the VA health care system, including the deployment of a system-wide electronic health record and a comprehensive quality improvement and performance management system.
The health insurance plans for the nation’s 22 million military veterans fall into three categories. The majority, 56 percent, have private health insurance or are covered by a non-VA health plan. Thirty-seven percent receive health-care services through the Department of Veterans Affairs (VA) health care system, which bases eligibility on having a service-connected disability, low-income level, and net worth or other specific circumstances.
More than 80 percent of VA enrollees older than 65 years also are covered by Medicare, and about 25 percent are beneficiaries of two or more non-VA-federal health plans, such as Medicare, Medicaid, TRICARE, or Indian Health Service. Seven percent of veterans have no health insurance.
The Affordable Care Act will expand health-care choices and potentially increase convenience and timeliness of care for veterans, but Kizer believes that having more health-insurance options can also cause fragmentation, diminishing continuity and coordination of care, resulting in more emergency department use, hospitalizations, diagnostic interventions, and adverse events.
He believes it also may shift care from VA facilities with experienced staff to private practice physicians who may be less prepared to treat conditions prevalent among veterans, and potentially result in decreased use of VA facilities, endangering volume-sensitive services, such as intensive care or complex surgery, which can affect local access to care and some health-care worker training programs.
In addition, with more than 30 million newly insured persons nationwide seeking services, some VA and non-VA facilities in rural and medically underserved areas already struggling with health-care worker and specialist shortages may be overwhelmed with increased demands for care.
According to Kizer, increasing health-insurance options for VA health-care enrollees will also increase redundant spending for veterans’ health care.
“In 2009, the VA spent $3.2 billion to care for nearly 775,000 veterans who were also enrolled in Medicare Advantage plans,” Kizer says. “These expenditures were overwhelmingly for routine inpatient and outpatient care covered by the Medicare Advantage plan, but federal law precludes the VA from being reimbursed for services provided to Medicare Advantage beneficiaries. As a result, the federal government paid twice for care of the same person in many instances.”
Kizer has three recommendations to streamline services and costs in preparation for the post-Affordable Care Act health-care environment, the first of which is to comprehensively evaluate and prioritize solutions for coordinating VA and non-VA health-care resources for veterans.
Second, assess current and projected VA health-care workforce needs and service utilization vulnerabilities, including expansion of telehealth and home-care services, and third, develop a shared vision for veteran’s health care considering its role as a safety net provider, the declining numbers of World War II and Vietnam War veterans, the increasing number of female veterans, and variables affecting federal funding.
More news from UC Davis: http://www.news.ucdavis.edu/
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6 Comments
George Dorn
Josh Lanier
I agree that it is quite a stretch to connect this paper by Kizer — which is essentially about possible (actually just conceivable) fragmentation of access for some unquantified number of Veterans, perhaps-maybe, sorta-kinda, because of more choices in private or employer health insurance as a result of the ACA, as compared to prospective benefits of more coordinated care within the VA system, kinda, could be — with the sensational headline and picture above. And I say that as a disabled Vet with care totally provided by the VA. A real stretch. Big. Straining credibility.
In a Youtube address just in excess of a year ago, President Obama cryptically alluded to his administration’s acknowledgment of the healthcare fraud epidemic with phrases like “rooting out squander” and “unwanted investing” and promises to “make drug makers fork out their truthful share,” calling on health professionals and hospitals to stop “unwanted therapies and assessments-but like most politicians he presented no concrete schedule for a method. On March 21 of this calendar year, he signed the Individual Safety and Cost effective Care Act, H.R. 3590 – which contains a amount of probable fraud-fighting measures-but still there was no mentioned benchmark and no roadmap from the White Dwelling to eradicate fraud and abuse in the health care model.
Right now thirty or so services and organizations, from the rapidly food items large McDonald’s (115,000) to Maverick County (one), have used for and received waivers excluding them from the recent healthcare laws/needs. These entities will not be requested to adhere to the minimal annual benefit level which is bundled in decreased-charge health and wellbeing policies. These designs are primarily generally put to use to go over piece-time or very low-wage staff, and will affect more than a million families nationwide.
EKIM
Kizer is only hoping to get more VA services privatized so they can rape the Govt for veterans care. The fact is these #’s are old, a vast majority of recent veterans are flocking to the VA. Every vet gets classes on VA benefits when they are discharged. So many more are aware of theri beneifits and are crowding an already unsustainable GOVT SERVICE.
Scot
Why is there such a thing as a eneligable vetern ??
I understand his viewpoint, but really how is the current health care system treating US Veterans if the majority have private insurance according to the statistic given? And how does the current system deal with a large number of veterans who simply are not covered under any plan and don’t have health insurance because they can’t afford it? It’s important to be critical of any new health plan that will go into effect, but the burden of proof is on the present medical system in the US that is in dreadful need of being updated and providing health care to the majority of Americans, especially veterans who have no health insurance. Also, does Kizer really speak for the majority of health researchers engaged with this issue? The US national health care system is lagging behind the rest of the world and Obama is really the first president to move forward in implementing a system that can actually provide treatment to a large population of Americans who can’t afford private health care. In terms of affordable health care you’d be better off in Cuba, which is embarrassing (and ironic) to say the least.