Sunday, April 26, 2015

How veterans are choosing health coverage (and why)

March 24th, the Senate Veterans Affairs Committee held a hearing on the Veterans Choice Act.  Among the witnesses appearing before the Committee were VA Deputy Secretary Sloan D. Gibson and Dr. James Tuchschmidt who is the VA's Acting Principal Deputy Under Secretary for Health.

In that hearing, many issues were addressed.

The issue we found particularly interesting was about veterans using other forms of medical coverage than VA.

Sloan explained that 70% of veterans are using the VA for prescriptions because it's "cheaper than getting their prescriptions filled elsewhere."

However, outside of that, the VA isn't pulling in majorities.

That became obvious in the exchange with Senator Thom Tillis (pictured above).

Deputy Secretary Sloan D. Gibson:  Two-third of our veterans over 65, they're Medicare eligible and they're already getting half of their care outside of VA.  We were talking earlier about continuity of care issues and how do you manage veterans health.  That's already a big challenge.

Senator Thom Tillis: That explains the date breakdown.  21 million veterans and 9 million of them --

Deputy Secretary Sloan D. Gibson:  Yes.

Senator Thom Thillis: -- using the system.

What does it mean financially to the US government if veterans over 65 are moving from VA coverage to utilizing Medicare instead?

James Tuchschmidt: If you look at our patient population today, 81% of them have some other form of insurance other than VA.  Two-thirds have Medicare.  So I think the question is if they're if the Out Of Pocket costs are different, lower than the VA, and the transactional cost are lower because you are not driving some place and the VA will pay for it, what is -- And that's the big question we're asking -- is "What percentage of that care will shift to some other payer to VA?"  In the end it might actually be cost neutral across the board for the federal government if the shift is from Medicare to VA.  But - but there clearly is a difference where that care is going to get paid.

What it means is likely a "cost neutral" effect since the federal government is the payer if its VA or Medicare.

What it means in terms of other issues?

The Committee failed to grasp -- because the witnesses didn't explain it -- a primary reason why a veteran might opt for Medicare over VA.

If you're going to a non-VA doctor for any reason and you want to use your VA coverage, you are required to secure a referral authorizing the visit from the VA.  This is not just an oral permission.  It must be on paper and you must present it at your appointment for your visit to be covered.

The Committee has not addressed this issue or the amount of time it imposes on veterans or their primary care givers.

If you're over 65 and you're going to a non-VA doctor and choose to ignore VA coverage but let Medicare cover it instead?

All you have to do is provide your Medicare number.

You don't need a referral.

This is an issue the Senate and House Veterans Affairs Committee should be exploring.


Kat, Wally, Ava and C.I. attended the hearing -- we're working from Ava and C.I.'s notes on the hearing for the above.
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