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By Tom Philpott
If John Kerry has his way, any veteran who served two years on active duty, or even less if mobilized, would be rewarded with lifetime access to healthcare from the Department of Veterans Affairs (VA).
That's the logical consequence of Kerry's call for "full mandatory funding" of veterans healthcare if the Democratic presidential nominee is elected and Congress accepts his plan to open VA healthcare to any veteran.
"What's critical is that people who served their country and want to go to a veterans hospital will have the ability to choose to do so," Kerry said in a phone interview Aug. 18 after his address to the Veterans of Foreign Wars in Cincinnati.
The Bush administration opposes mandatory funding of VA healthcare. It would require Congress to finance VA healthcare to a level sufficient to cover medical needs of all enrollees, using a per-capita cost formula.
Mandatory funding would, in effect, put teeth into the Veterans' Health Care Eligibility Reform Act of 1996, which first authorized the opening of VA healthcare to any veteran. Congress did not fund open access, instead giving the VA secretary authority to control access to stay on budget.
The Congressional Budget Office estimates the added cost of mandatory VA health funding at $30 billion in fiscal 2005 and more than $165 billion from 2005 through 2008. That assumes many more veterans would enroll. Current enrollment is 7 million veterans, but only 5.2 million are expected to receive care in 2004.
As conceived by Kerry and congressional Democrats, mandatory funding also would remove barriers to enrollment, which would mean reversing a decision by VA Secretary Anthony Principi in January 2003 to suspend enrollment of Category 8 veterans — those with income or total worth above poverty level and no service-connected injuries or ailments.
"We have a responsibility to the American people to be efficient, effective and to provide high-quality care," Principi said. Mandatory funding would end some of the "checks and balances" to do that.
Kerry has criticized Bush's proposals to collect a $250 annual healthcare enrollment fee for veterans with no service-connected conditions and above-poverty incomes, and to increase their co-payments on VA-provided drugs from $7 up to $15 for a 30-day supply.
Principi defended the enrollment fee and co-payments, calling them reasonable cost-control initiatives. If it's OK for an E-6 retiree to pay $230 a year to enroll in TRICARE Prime, why is it inequitable for a veteran who served two years, who doesn't have a military-related disability, to pay $250? he said.
John Brieden, national commander of The American Legion, said his organization and other major veteran groups are strong proponents of mandatory funding. Congress in 1996 voted to restore VA access to all veterans, "but they never intended to fund it," Brieden said.
Kerry now says he will.
Bush won't, which leaves his VA secretary defending an overall record of commitment to veterans, which includes, he says, a 40 percent rise in VA health budgets over four years.
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