On the Hill - The Health Care Debate & Veterans

Reprinted from PN/Paraplegia News August 2017

By the time Congress rolls into the August recess, the House of Representatives and Senate may have passed “repeal and replace” measures for the ACA.

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The Health Care Debate & Veterans

The summer of 2009 could have easily been defined as the “summer of discontent,” as the debate over the Affordable Care Act (ACA) raged in Congress and across the country. This summer looks to possibly be déjà vu all over again. By the time Congress rolls into the August recess, the House of Representatives and Senate may have passed “repeal and replace” measures for the ACA. In fact, this past May, the House passed its repeal bill known as the American Health Care Act (AHCA). At press time in late June, the Senate was in the process of negotiating its own version of “repeal and replace” legislation that would reshape the broader health care marketplace. Paralyzed Veterans of America (PVA) was an active participant in the 2009 and 2010 debates over the ACA, as it fought to ensure protections for both veterans and people with disabilities as a part of larger health care reform. PVA has reaffirmed its commitment once again as the health care reform debate rages anew.


Unfortunately, the House and Senate are attempting to repeal and replace the ACA through a legislative process known as reconciliation. This process allows legislation to be moved on a simple majority vote, thereby circumventing the filibuster rules that often stymie legislative action in the Senate. The reconciliation process requires the House and Senate to adhere closely to budget rules. Any legislation that addresses policy matters external to the budget process or that requires action by the authorizing committees eliminates the availability of reconciliation as a tool. The House-passed AHCA retains positive aspects of the current system originally established by the ACA, such as the continuation of dependent insurance coverage to age 26 and premium tax credits to make insurance affordable. However, PVA has serious concerns about several critical issues, particularly ones that impact veterans, which are being overlooked as a result of the reconciliation process. Currently, little attention is being paid to the impact of those changes proposed by the AHCA and being considered in the Senate on veterans with disabilities within the Department of Veterans Affairs (VA) health system, as well as the many veterans who, for various reasons, don’t engage with the VA. 

Problematic Policies

For veterans and PVA members in particular, the AHCA continues several problematic policies of the ACA and introduces troubling new provisions that could affect the ability of many veterans and their families to afford health insurance in the private market.

The underlying AHCA bill:

  • Continues to exclude Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) beneficiaries — dependents of the most catastrophically disabled veterans — from the dependents’ coverage policy up to age 26
  • Fails to remove the prohibition on enrollment into the VA health care system for Priority Group 8 veterans, thus denying these veterans access to the principal health care system for veterans 
  • Denies access to tax credits making health insurance affordable to anyone eligible for a host of other federal health programs, including those “eligible” for coverage under Title 38 health care programs. This would prevent many veterans who may be “eligible for” but not enrolled in the VA health care system from accessing these tax credits intended to help people buy insurance. In order to address this problem, legislation called the Veterans Equal Treatment Ensures Access Now (VETERAN) Act (HR 2372) has been introduced in the House.

It appears the bill being developed by the Senate will continue to exclude dependents of catastrophically disabled veterans from current policies that provide for dependent insurance coverage up to age 26.

Specifically, unlike almost every other private and government health care plan, CHAMPVA beneficiaries are barred from the dependents’ coverage policy up to age 26. Sen. Jon Tester (D-Mont.), ranking member of the Senate Committee on Veterans’ Affairs, has introduced the CHAMPVA Children’s Care Protection Act of 2017 (S 423) that would rectify this oversight, but its language can’t be included under
reconciliation rules.  

Lost Coverage?

Finally, there are over 1.7 million veterans who currently rely on Medicaid. Some 340,000 of those veterans are covered under the Medicaid expansion that took place as a result of the ACA. Approximately 40% of those veterans are between the ages of 18 and 64 and have no other source of health coverage. In addition, as of 2015, over 600,000 veterans’ spouses were enrolled in Medicaid, demonstrating the importance of that program in supporting many veteran caregivers.   Under the significant cuts proposed for Medicaid, these veterans and their family members may lose this coverage as states find it necessary to constrain spending in this program. Unfortunately, many of these problems can’t be addressed as a result of reconciliation. As a result, the PVA Government Relations staff will remain actively engaged with members of Congress to take necessary actions to address these oversights. PVA needs its members and supporters to engage as well. As members of Congress spend this month home in their districts, PVA encourages you to meet with them and express the aforementioned concerns to them. They need to hear from you if PVA hopes to enact meaningful health care reform that has a positive impact for veterans and people with disabilities. 

Carl Blake is the associate executive director of PVA’s Government Relations Department, and Susan Prokop is a senior associate director for advocacy in the department.


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On the Hill - The Health Care Debate & Veterans


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