If John Kerry has his way, any veteran who served two years on active duty or, if mobilized, even less, would be rewarded with lifetime access to health care from Department of Veterans Affairs.

That’s the logical consequence of Kerry’s call for “full, mandatory funding” of veterans health care, if the Democratic presidential nominee is elected and Congress accepts his plan to open VA health care 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,” said Kerry, in a Wednesday phone interview after his address to the Veterans of Foreign Wars in Cincinnati.

The Bush administration opposes mandatory funding of VA health care. It would require Congress to finance VA health care to a level sufficient to cover medical needs of all enrollees, using a per capita cost formula.

Mandatory funding, in effect, would put teeth into the Veterans’ Health Care Eligibility Reform Act of 1996 which first authorized the opening of VA health care to any veteran. But Congress did not fund open access. Instead it gave the VA secretary authority to control access in order 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 will enroll upon learning that VA funding is assured. Current enrollment is 7 million veterans but only 5.2 million were 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.

Principi said not only would mandatory funding add many billions of dollars to VA health care costs but it would dampen VA and congressional oversight of health care spending by relying on a formula.

“We have a responsibility to the American people to … be efficient, effective and to provide high-quality care,” said Principi.

Principi said mandatory funding could change the VA from a provider of health care to a “payer” for health care, and bring “serious unintended consequences.”

VA already “vouchers out” a rising portion of care because VA hospitals and clinics can’t meet demand. Mandatory funding would accelerate this growth, though contracting for care is preferred to building more hospitals and clinics which, by 2020, could be deemed excess as veterans from World War II and Korea pass on.

Principi’s concern is that as more care is contracted out, the VA could begin to look like any national health care system, and pressure would mount to merge, perhaps with Medicare. If that happened, he said, the uniqueness of VA health care, from expertise in treating spinal cord injuries to vast experience with posttraumatic stress disorder, could be lost.

Kerry, in his VFW speech, promised to “lead the fight” for mandatory funding, referring to 500,000 veterans denied enrollment from the ban on accepting more Category 8 veterans. Later, in our brief conversation, Kerry didn’t balk at the prospect of lifetime care going to veterans with little time in service and no exposure to combat or service-connected ailments.

“I have a plan that’s going to provide health care to 97 percent of Americans within three years of the passage of the bill,” said Kerry. “So it is absolutely logical that veterans should be a priority within that structure.”

In his speech, he criticized Bush administration proposals to collect a $250 annual health care 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 proposed enrollment fee and higher co-payments, calling them reasonable cost-control initiatives.

— To comment, write Military Update, P.O. Box 231111, Centreville, VA 20120-1111, e-mail or visit

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