1.8 million veterans lack health coverage

Of the 47 million uninsured Americans, one in every eight (12.2 percent) is a veteran or member of a veteran’s household, according to a study by physicians from Cambridge Health Alliance who are also Harvard Medical School researchers. The study is published in the December issue of the American Journal of Public Health. Approximately 1.8 million veterans (12.7 percent of nonelderly veterans) were uninsured in 2004, up 290,000 since 2000, the study found. An additional 3.8 million members of their households were also uninsured and ineligible for VA care.

The study is based on detailed analyses of government surveys released between 1988 and 2005. Veterans were classified as uninsured only if they neither had health insurance nor received ongoing care at Veterans Health Administration (VHA) hospitals or clinics. A preliminary review of 2006 data released last month (while this study was in press) shows little change in the number of uninsured veterans since 2004.

“Like other uninsured Americans, most uninsured vets are working people — too poor to afford private coverage but not poor enough to qualify for Medicaid or means-tested VA care,” said Steffie Woolhandler, a physician at Cambridge Health Alliance and an associate professor at Harvard Medical School. Woolhandler testified before Congress about the problem earlier this year. “As a result, veterans and their family members delay or forgo needed health care every day in the U.S.,” said Woolhandler.

Findings of the study include the following:

• The number of uninsured veterans has increased by 290,000 since 2000, when 9.9 percent of nonelderly veterans were uninsured, a figure that rose to 12.7 percent in 2004.
• Of the roughly 1.77 million uninsured, 645,628 were Vietnam-era veterans while approximately 1.11 millions were veterans who served during “other eras” (including the Iraq and Gulf wars).
• Of uninsured veterans, 56.5 percent were older than 44.
• Uninsured veterans had as much trouble getting medical care as other uninsured Americans. More than a quarter (26.5 percent) of uninsured veterans reported that they had failed to get needed care due to costs; 31.2 percent had delayed care due to costs; 49.1 percent had not seen a doctor within the past year; and two-thirds failed to receive preventive care.
• Nearly two-thirds of uninsured veterans were employed.

Many uninsured veterans are barred from VA care because of a Department of Veterans Affairs order in early 2003 that halted enrollment of most middle-income veterans. Others are unable to obtain VA care due to waiting lists at some VA facilities, unaffordable co-payments for VA specialty care, or the lack of VA facilities in their communities.

“The number of uninsured vets has skyrocketed since 2000, and eligibility has been cut, barring hundreds of thousands of veterans from care,” said David Himmelstein, lead author of the study, a physician at Cambridge Health Alliance, and associate professor of medicine at Harvard. “We need a solution that works for veterans, their families, and all Americans — single-payer national health insurance,” he said.

“I see uninsured vets in my clinic every week,” said Jeffrey Scavron, a former Navy physician in Springfield, Mass. “In many cases, they’re too sick to work, but not yet sick enough for full disability, which would qualify them for Medicare. Only the government can put men and women into military service, and only the government can guarantee that they are covered after they serve.”