Since January 2003, nearly 400,000 veterans have been denied enrollment in the Department of Veterans Affairs (VA) health system because they have no service-connected disabilities and have incomes that exceed a VA means test, the same one used to screen for federal housing assistance.

The Bush administration’s decision to suspend enrollment in VA health care for these “Priority Group 8” veterans was explained four years ago as necessary to ensure continued access to VA care for higher priority veterans — those with service disabilities, low incomes or special needs.

Whether Congress should force the administration to reopen the VA system to new Group 8 enrollees was the topic of a contentious hearing Wednesday of the House Veterans Affairs Committee.

The timing might seem questionable given how veterans physically and mentally wounded in Iraq and Afghanistan are a rising challenge for VA medical staffs and resources. But the treatment of Priority 8 veterans is tied to Democratic election promises of “full funding” for VA health care. Also, it’s an issue guaranteed to light off partisan fireworks on which so many lawmakers today seem to thrive.

For many years, veterans who were not disabled or indigent could gain access to VA facilities only on a case-by-case and space-available basis, said Michael J. Kussman, VA’s under secretary for health. It was the Veterans’ Health Care Eligibility Act of 1996 that directed VA to build many more clinics and establish an enrollment system based on seven and later eight priority groups.

Suddenly, starting in 1999, VA health care was opened to any veteran. Over the next three years, the proportion of higher-income, nondisabled veterans enrolled the VA system climbed to 30 percent. By 2003, then-VA Secretary Anthony Principi decided the flood of Group 8 veterans was endangering the system’s ability to care for higher priority veterans. He used his authority under the 1996 law to suspend new Group 8 enrollments. Those already enrolled were unaffected. Group 8 veterans remain 27 percent of all VA care enrollees.

Rep. Bob Filner (D-Calif.), committee chairman, said the current situation represents “unacceptable” rationing of care, noting that veterans without disabilities are denied enrollment if incomes rise above $27,790. He tied the need to reopen VA care to any veteran to sacrifices being made in current conflicts.

“Any planned military surge must be accompanied by a surge for health care for veterans. We must be prepared to serve those that have served us — and we are not prepared at this time,” Filner said.

But Republicans argue that wars in Iraq and Afghanistan, in fact, make opening VA health care to all veterans more difficult given the rising strain on staff and resources. Also, Group 8 veterans who have served in these wars do, in fact, gain access to VA health care for two years under current law. And if they enroll during that period they can remain enrolled.

Rep. Steve Buyer (R-Ind.), the committee former chairman and ranking Republican, said VA needs to do more for disabled veterans and those in financial need — the VA’s “core constituency” — rather than “open the gates” for a “surge” of Group 8 veterans.

The VA estimates that 1.7 million new Group 8 veterans would enroll, if given the chance, and 600,000 would seek VA care. The added cost to VA over the next 10 years would be $33 billion.

Filner shot back that Buyer and Republican colleagues are all too willing to “support a surge when it comes to military action but cannot have a ‘surge,’ in your words, when it comes to treating our veterans.”

The first witness Filner called to testify was Dr. Steffie Woolhandler, a professor of medicine at Harvard and co-founder of Physicians for a National Health Program. She cited 2004 surveys showing 1.8 million veterans had no health insurance and were not receiving VA care. An additional 3.8 million persons living with these veterans also lack health coverage.

Republicans pounced. Buyer said it was hard to get past the title of Woolhandler’s testimony, “Uninsured Veterans: A Stain on America’s Flag.” Buyer said he found it particularly galling given that Woolhandler is on the faculty of a university that has such an “anti-military bias” that it won’t support an ROTC program or allow recruiters on campus.

“You’re changing the subject,” Woolhandler said. “This is not about Harvard.” She said the topic is access to care for all veterans. It “breaks my heart,” she said, when she come across veterans denied VA health care.

“VA should be an important safety net and it’s not,” she said.

But Buyer and Republicans Jeff Miller and Cliff Stearns, both of Florida challenged Filner and Woolhandler on other points. Stearns noted that the $27,790 means test for Group 8 veterans can be much higher. In San Francisco, for example, non-disabled veterans aren’t denied VA enrollment unless household income for a veteran with one dependent exceeds $70,000.

Buyer and Miller suggested Democrats want VA health care open to all veterans as a first step toward a national health program. Woolhandler conceded that she envisions a day when veterans will be able to choose between care in the VA or using a national health insurance card anywhere else. But she disagreed with Stearns that this could lead to deterioration of care quality within the VA system.

Filner excused Woolhandler as a witness, ignoring Buyer’s protests that he and colleagues had more questions. Next to testify was a panel representing veterans’ service organizations who want VA care open to any veteran. But the system, they said, must be fully funded to care for every enrollee.

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