As Congress heads home for its July 4 recess, the Republican Senate leadership remains determined to press toward a July vote on a bill that would eviscerate Medicaid and repeal the Affordable Care Act (ACA). Despite assurances to the contrary, the Senate’s Better Care Reconciliation Act closely mirrors the massively unpopular American Health Care Act passed in May by a narrow Republican majority in the House of Representatives. What many members of Congress and their constituents may not realize is that war veterans and their families will also be among the millions of seniors, individuals with disabilities and working age men and woman seriously hurt by this legislation.
All told, 1.8 million veterans rely on Medicaid health care, services and support – 340,000 of whom gained access to Medicaid thanks to federal funding under the ACA that enabled 31 states and the District of Columbia to close gaps in health care coverage. This number does not include the 1.5 million family members of veterans who are not eligible for VA care and who solely rely on Medicaid for health care services.
We now know that there is a much larger percentage of veterans living with a daunting array of war-related physical and psychological wounds than was previously understood. According to a 2014 non-partisan Congressional Budget Office analysis, 44 percent of the 2.7 million veterans who served in Vietnam, and 43 percent of the 1.6 million veterans who served in the Gulf War, Iraq and Afghanistan have recognized service-related disabilities that will require ongoing care for the indefinite future. Care today that is predominantly provided by the VA system or through Medicaid.
Army veteran and Gold Star wife Sylvia Earhart of Colorado Springs, Colorado knows all too well what veterans stand to lose if the Senate bill becomes law. Sylvia’s son has Down’s syndrome and autism, and Medicaid provides the care he needs. He has a hole in his heart, his hips needed severe reconstruction – requiring him to use a wheelchair – and he’s undergone countless surgeries over the years. The nearly $840 billion in Medicaid cuts in the Senate has proposed could not only end critical services, including school and home-based support services that support his continued development, but also impede his access to care.
Where will our veterans like Sylvia and her family get the care that they need in the future?
While the VA system provides excellent care for veterans dealing with the physical and psychological “wounds of war,” many veterans are unable to access VA facilities, because such facilities are unevenly distributed across the country. Rather than expand the VA system, President Trump’s hiring freeze has contracted it. With 40,000 (and rising) unfilled VA clinical and support positions, the increasing barriers to access are forcing veterans to reluctantly end trusted relationships with VA clinicians and seek care “elsewhere.”
However, if the president and most Republicans get their way and eviscerate Medicaid, there would be no “elsewhere” to go to. There would be no guarantee of Medicaid to support needed services and there would be a nearly $840 billion cut in federal Medicaid funding, leaving the states to fend for themselves. Thus, the combination of the VA hiring freeze and the dismantling of Medicaid is nothing less than a “declaration of war” on our wounded veterans. There is no other way to say it.
Rightly or wrongly, our nation has asked our veterans to make extraordinary sacrifices as well as endure suffering and loss that for many will last for a lifetime. Our veterans deserve all the care and services that can best heal their psychological and physical wounds. It now falls to the Senate to affirm without ambiguity that it will meet America’s obligation to our wounded veterans as well as to the millions of Americans who will be harmed in the rush to dismantle critical components of our health care system.
Robert Master, MD, is the founder and president and CEO emeritus of the Commonwealth Care Alliance and captain U.S. Army MC, 101st Airborne Division, Vietnam (1969-1970)