Story URL: http://news.medill.northwestern.edu/chicago/news.aspx?id=222612
Story Retrieval Date: 4/17/2015 12:24:50 PM CST

Top Stories
Features
Daniel Cruz USMC

Courtesy of Daniel Cruz

Daniel Cruz (left) joined the U.S. Marine Corps after 9/11, but had no health insurance after he left the service in 2006, despite qualifying for care through the Department of Veterans Affairs.


Veterans without VA health care eligible for Medicaid through Obamacare

by Esther Bergdahl
June 05, 2013


Related Links

Uninsured Veterans and Family Members: State and National Estimates of Expanded Medicaid Eligibility Under the ACAUninsured Veterans and Family Members: Who Are They and Where Do They Live?State Summary: Illinois and the U.S. Department of Veterans Affairs

Veteran spouses also benefit from law

Nationwide 174,000 uninsured spouses of veterans -- 1 in 4 uninsured veteran spouses --  have incomes below 138 percent of the federal poverty line, qualifying them for the Medicaid expansion under the Affordable Care Act, according to the recent study, though the majority live in states that are not participating in the expansion.

In Illinois, a participating state, that number is nearly 18 for every 1,000 veteran spouses.
When Daniel Cruz left the U.S. Marine Corps in August 2006, he became one of thousands of Illinois veterans without health insurance, despite being eligible for coverage through the Department of Veterans Affairs.

“I never went to the VA afterwards,” Cruz, 29, of Chicago, said. “I got unemployment, and that was my benefit. I didn't know any better.”

More than half a million uninsured veterans could start receiving health care when Medicaid expansions that are part of the Affordable Care Act kick in next year, even though many of them also qualify for treatment through the VA system. Nationally, 1.3 million nonelderly veterans have no health insurance.

“Uninsurance among veterans is associated with greater problems accessing needed care,” said Jennifer Haley, research associate at the Health Policy Center at the Urban Institute, who co-led the study. “Increased Medicaid coverage could close coverage gaps and increase the likelihood that their health care needs are being met.”

Four in 10 uninsured veterans have incomes below 138 percent of the federal poverty line, which means that under the new terms of the Affordable Care Act, these veterans might qualify for health insurance or subsidies for coverage if they live in participating states, according to a study released in March by the Urban Institute and the Robert Wood Johnson Foundation.

About 42 of every 1,000 veterans in Illinois have no insurance, according to the study, which translates to nearly 34,000 uninsured Illinois veterans. Nationwide, 1 in 10 veterans under the age of 65 is uninsured. The data used to power the study comes from the U.S. Census Bureau and does not report why uninsured veterans do not use VA health care.

VA care is only available through VA providers, so the location can be a problem if no VA facility is convenient, said Haley, adding that proximity issues particularly affect rural communities.

“Medicaid providers could be more convenient for [these veterans], if the VA facility is too far away,” she said.

Proximity may not be the only issue at hand, however. Some veterans may be avoiding VA care by choice.

Cruz, who served with the Marines for five years, had no health insurance until he became a full-time student at Northeastern Illinois University in August 2007. His desire for insurance was a factor in the decision, he said, and added that being uninsured also changed his behavior.

“I didn't get into motorcycles because I don’t want a motorcycle accident. I didn't get into any kind of sports at school,” he said.

After he was discharged, Cruz received enrollment paperwork from the VA, as well as a deadline to submit it, he said.

“It just seemed so complex that I would rather just suck it up than go through the hassle,” he said. “I just wanted to enjoy some freedom and not deal with their system.”

Eligible veterans can apply for VA health benefits online, over the phone or in person at a local VA health facility, according to the VA website. The online application involves an interactive PDF document, which requires a specific software update and does not display on certain computers.

Multiple calls to VA representatives for comment were not returned.

For Cruz, it’s not just a matter of avoiding bureaucracy and time-consuming paperwork. Military culture itself may have a hand in why he doesn’t seek VA health care, he said.

“For me, it’s a bit of a pride thing,” he said. “I don't know if that’s something embedded in me when I served, or something that I got from the media, but I do feel pride that I don't collect benefits from the military.”

The simplest answer for why veterans go uninsured may be one of knowledge gaps, according to Haley.

“Most veterans are unaware that once they leave the military, they can still enroll in VA care,” she said. “It could be that the VA needs to better publicize that the VA care is available.”

Cruz said that he has changed his mind about applying for VA coverage, and that he feels he has nothing to lose from trying to supplement his student insurance.

“That pride thing, you have to put that aside and get what you deserve,” he said. “I’m being more open to actually going through the process right now than when I first got out.”