- The Veterans Health Administration (VHA) has been under considerable scrutiny because of ongoing scandals; an independent evaluation found the VHA lacking.
- This article examined the cost impact of enrolling veterans (the 9.079 million who are currently enrolled in the VHA, the 6.633 million who use the VHA for care, or the 1.757 million VHA users who have no other health insurance available).
- The analysis found providing a full Part A, Part B, and Part D benefit, as well as Part D deductibles, and donut hole coverage and a Medigap policy would cost considerably less than current VHA medical care funding.
- Using Medicare to provide care for veterans could rapidly increase access, has the potential to improve outcomes, and would save taxpayers money.
- Policymakers and politicians will need to determine whether providing less-expensive, higher-quality, and more accessible care to the nation’s veterans is worth the challenges inherent in shedding expensive assets from, and downsizing, the largest government employer.
Approximately 2 years ago, a scandal revealed widespread and long-standing fraud within the Veterans Health Administration (VHA). Administrators resigned, new leadership was installed, and Congress passed the Veterans Access, Choice, and Accountability Act of 2014 (the Act). A recently released independent assessment of VHA management and care processes that was commissioned within the Act found inconsistent performance, excessive bureaucracy, and a trajectory of capital costs that was “unsustainable.” Seemingly, the Federal Government must invest substantial additional resources in the VHA or explore alternative ways to provide healthcare for the nation’s veterans.
Background
Veterans deserve the nation’s greatest respect; their lives have been disrupted by deployment and put at risk to protect our freedoms. Since the Revolutionary War, Americans have supported a number of benefits for veterans, including the establishment of a separate bricks-and-mortar healthcare system in 1930.
Although that made sense when veteran numbers were high and health insurance was unavailable, the size and needs of the veteran population have changed. Between 2001 and 2014, the number of US veterans declined by 17% and the proportion of enrolled veterans who use the VHA decreased from 76% to 65%. Also, most enrolled veterans, even those who use the VHA for primary and specialty care, get most of their healthcare outside the VHA, funded by other insurance. Therefore, although the fiscal year 2014 VHA cost per enrollee of approximately $6344 ($57.591 billion in medical care costs divided by 9.079 million enrollees) may seem reasonable at first blush, it may appear less so when considering that it provides partial benefits to veterans who also use other insurances to get healthcare.
In this context, it may not be rational to continue to support an independent VHA healthcare delivery system. Instead of further investment in a challenged, government-run healthcare delivery system, alternatives to meet the healthcare needs of veterans who qualify for VHA care must be considered.
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-William B. Weeks, MD, PhD, MBA
This article originally appeared in the June 2016 issue of The American Journal of Medicine.
