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By BILL SMITH Times Leader Columnist
Sunday, March 09, 2003 Page: 11A
Just as soon as the Veterans Affairs 2004 budget was picked up from the
Internet, questions were being asked if what appeared had any substance. The
question is to raise the co-op pharmaceutical fee from $7 to $15. Now that’s
one giant step in any increase, especially when the original price was $2.
The Office of Public Affairs Media Relations provided the following
information: “Since the FY 2004 budget request includes a large discretionary
increase, will the department reverse its recent decision suspending health
care enrollment for Priority Group 8 veterans?”
The secretary’s decision to suspend new enrollments in VA’s health care
system for Priority Group 8 veterans was made to allow the department to
refocus its health care resources on serving those veterans who need it most:
those with service-connected conditions, those with lower incomes and those
with special health care needs, such as blindness, amputations or spinal cord
injuries.
Even with the budgetary increase, a large number of higher incomes,
non-disabled veterans enrolling in the VA health care system would prevent the
VA from focusing on its core constituency and reducing waiting times.
Regardless of what future decision is made regarding enrollment, it is
worth noting that we are exploring other possibilities for making VA health
care available to all veterans.
As an example, we are working with the Department of Health and Human
Services to develop a plan that will provide non-enrolled Priority Group 8
veterans the option of using their Medicare benefits to obtain their care from
the VA. Federal government agencies are operating under a continuing
resolution because Congress has not yet passed and sent a FY 2003
appropriations bill to the president for signature.
“Expected FY 2003” refers to the funding level we believe will be
established in the budget that will be sent to the president soon.
Fee change
The proposed change in the annual enrollment fee is to charge a $250 annual
enrollment fee for non-service-connected Priority 7 and Priority 8 veterans
beginning Oct 1.
It is expected by 2004 that this fee would reduce enrollment by 1.25
million (485,000 NSC and 770,000 Priority 8).
Primary co-payment raising effect
Veterans whose annual incomes do not exceed the base pension rate, which
for a single veteran is $9,690, are required to pay a VA co-payment for each
30-day or less supply of outpatient medication.
This proposal would raise the threshold to the base Aid and Allowance rate,
which for a single veteran is $16,169. This proposal would allow more veterans
to receive outpatient medications without being subject to a medication
co-payment. (It is estimated by the VA that this will save approximately $33
million next year.)
According to this proposal, it would allow the VA to raise the medication
co-payment amount for Priority 7 and Priority 8 veterans from $7 to $15 for a
30-day supply of medication, beginning Oct. 1. This would result to an
additional revenue of approximately $65 million a year.
Ominous?
As the old saying goes, “Where there’s smoke there’s fire!” Even those,
who, according to the Office of Public Affairs, Media Relations, are not to be
affected by this proposal, are optimistic about their individual categories
being altered. It seems that the raise in VA-provided prescription drugs from
$2 dollars to $7 dollars came out of the blue with little opportunity to offer
input into the raise.
That was a 250 percent increase. With the $15 dollar amount being bantered,
the percentage increase is downright outlandish. According to my limited
information, this action for increased co-payments came directly from the
office of the Secretary of Veterans Affairs, Anthony Principi.
Do it now
If you are concerned, and every veteran should be, now is the time to
contact your Washington legislators and voice your concerns about this
leaps-and-bounds increase. With giant steps being taken now to increase the
prescription co-pay amount, who knows what may be lurking in the future.
With the obituaries confirming the deaths of veterans each day throughout
the entire nation, it seems plausible that with such deaths comes the fact
that with each death, the possibility exists that the prescription drugs they
may have been receiving will no longer be dispensed. The proposal would allow
the VA to raise the co-payment when and if it is brought to the members of
Congress for their deliberations and decision.
Recalling the raise from $2 dollars to $7 dollars, it is my understanding
that it began and ended in the office of the secretary of Veterans Affairs and
Congress was not consulted. It was the decision of the secretary of Veterans
Affairs.
More
Today, there are approximately 26 million veterans, but within the next 20
years, this number will shrink to about 17 million. Although all veterans are
eligible for VA services, fewer than 6 million veterans participate in its
programs. It means that with a declining population fewer veterans will seek
medical care, monthly benefits, and burials at VA cemeteries.
On the immediate scene, however, veterans health care and other costs have
continued to rise. In 1996, a law was passed which allowed the VA to treat all
veterans in the most practical of settings. This law permitted the VA to
deliver care very similar to the private sector.
As a result, most VA care is now provided in clinics and homes rather than
hospitals. The 1996 law also required the VA to assign veterans receiving
medical care to one of seven priority levels. An eighth priority level was
later added.
These levels are designed to prioritize the need for care among veterans,
thus giving greatest performance to those with the most severe health problems
and the least financial resources.
Veterans with military disabilities, low incomes or special needs are given
higher priority levels in line with the VA’s core mission. Veterans without
these characteristics fall into the lowest levels (Priority Levels 7 and 8).
Based on the level of funding provided by Congress, the VA secretary
announces annually which priority levels of veterans are entitled to receive
care. Prior to the 1996, law veterans in the lowest two priority levels were
only treated if space was available, and they were restricted as to the kind
of care they would receive and where they would receive it.
However, since the law passed, these veterans have grown from 2 percent to
more than 31 percent of enrollees in 2002. The escalation in numbers will
require a growing portion of VA resources, reducing the resources available
for veterans with disabilities or low incomes.
As a result, 236,000 veterans now must wait six months or longer for an
appointment. The budget of the president includes a number of changes that
refocuses attention on the VA’s core medical care mission of providing needed
services to veterans with military disabilities or low incomes as well as
those with special needs. It assumes that, in early 2003, Priority Level 8
veterans will not be able to enroll if they are not yet using VA medical care.
However, Priority Level 8 veterans currently enrolled will not lose that
status. Priority Level 7 and Priority Level 8 veterans will pay an enrollment
fee, and increased drug co-payments. Institutional long-term care will only be
available to veterans with disability ratings of 70 percent or greater.
No veterans currently receiving care will be displaced. (It will be
interesting to monitor what action members of Congress will provide upon
requests from their veteran constituencies.)
Bill Smith is a Times Leader columnist who writes for and about veterans.
His column appears Sundays. To publish items in Views On Veterans, write to
Bill Smith, c/o Times Leader, 15 N. Main St., Wilkes-Barre, PA 18711-0250.