Congress must ensure a system that fairly prioritizes care for veterans

As thousands of veterans return from Iraq and Afghanistan in need of care, we must make sure those who are severely wounded get to the front of the line for health services. Unfortunately, certain members of Congress have been promoting legislation that would force our most seriously combat-wounded veterans to compete for places in long waiting lines. That is unacceptable. As we move forward this year with legislation to improve our veterans’ healthcare system, members of Congress should be very aware of a deceptively small issue that threatens healthcare for wounded veterans.

S.1233, the Veterans Traumatic Brain Injury and Health Program Improvements Act, contains many valuable benefits for veterans, such as increased travel benefits, help for low-income veterans, and traumatic brain injury program enhancements.

However, this bill also contains a provision that would throw hundreds of thousands, or more, new patients into an already strained VA healthcare system. These new patients are Priority 8 veterans.

So, who is a Priority 8 veteran? It’s an individual who has no service-connected disability, injury, or healthcare concern.

Did he or she serve? Yes.

Did he or she sustain any injury as a result of that service? No.

Is he or she living at or below the poverty level? No. Furthermore, research tells us that many of these individuals have employer-provided healthcare.

In 2003, the reality of rising costs and shrinking budgets during the ongoing conflicts in Iraq and Afghanistan led VA to limit healthcare services provided to Priority 8 veterans.

It’s worth noting at this point that many people mistakenly believe money is the only obstacle to providing all veterans with healthcare through VA. Actually, the problem is more complicated. Funds provided for new patients would be used for additional staff, equipment, and space. Therefore, it is important to know whether each of these goods or services are attainable.

The issue of whether VA has the capability to hire new staff should make anyone hesitate to open VA to Priority 8 veterans. It is widely known that the entire nation is struggling to find a stable supply of primary care physicians and nurses to provide basic healthcare services in non-VA facilities. A July 2007 report by the Health Research Institute of PricewaterhouseCoopers showed that the United States will be short nearly 1 million nurses and 24,000 physicians by 2020. In this environment, simply finding new staff to hire is a challenge for any healthcare system, including VA.

Even if necessary staff can be found, it’s questionable whether VA has the necessary clinical space in which to provide more primary and specialty care services. I am also skeptical that many VA facilities could open the additional operating rooms, post-surgical recovery units, and intensive care units that would be required with a large increase in patients. A recent analysis estimates that VA could not establish the needed infrastructure expansion until 2013.

There is also the financial cost of allowing Priority 8s back into the VA health care system. Last year, the VA budget rose by nearly 18 percent. In a year when many budgets were flat-funded, the Congress continued to provide double-digit increases to the VA budget. However, we would need to surpass even those extraordinary funding levels to handle such an influx of new veterans into the system. A recent analysis estimates that allowing Priority 8s into the system would cost upwards of $3.1 billion in the first year alone. After that, it is difficult to anticipate how many would leave their private health insurance plans and jump in line for free VA healthcare, but this same analysis put the cost at $16.9 billion to be spent on Priority 8s alone over the first 5 years.

This is not just my view. On the issue of re-opening VA to Priority 8s, the Disabled American Veterans stated that ”without a major infusion of new funding, enactment of this bill would worsen VA’s financial situation, not improve it, and would likely have a negative impact on the system as a whole.”

When Congress establishes priorities, we cannot ignore reality and the likely repercussions of our actions. Congress has been commendably responsive to the needs of our nation’s veterans, and I expect that responsiveness to continue.  But we must realize that despite our best motivations and intentions, allowing Priority 8s back into the VA system would be detrimental to the care of our seriously wounded veterans. That would be a step backwards, and one we should not take.

Craig is a member of the Senate Veterans’ Affairs Committee.