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Proceed with Caution: The Unintended Consequences of Expanding VA Access
Nina Owcharenko, Heritage Foundation, 3-17-06

Owcharenko advises policymakers to tread carefully before they expand the VA’s responsibilities beyond its core mission of “[serving] current combat veterans and veterans with service disabilities, lower-incomes, and special needs.” She notes that similar, well-intentioned expansions of the Medicaid program may have harmed recipients who rely on it for high quality care.

Incorporating a large pool of new beneficiaries with less-specialized medical needs into the system would alter the political and budget calculus of the VA system. Because beneficiaries with general needs would substantially outnumber beneficiaries with specialized needs, future attempts to control cost growth would likely restrict access to specialized care.

The experience of Medicaid, the government healthcare program for the poor, demonstrates the danger of expanding a healthcare program beyond its original purpose. The more Medicaid eligibility expands up the income scale, the more cost-containment measures are imposed to keep expenditures under control. However, many of these techniques actually put patients at greater risk. For example, limitations on prescription drug access in Medicaid have had significant adverse affects on some of the most vulnerable populations, such as the mentally disabled. In the VA system, the most vulnerable would be those veterans injured in service to their country.

In the long run, she thinks that a wiser course would be for Congress to offer “health insurance subsidies for certain lower-priority categories of veterans that would assist them in purchasing private health insurance coverage and related medical services.”

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