There are many uncertainties with the ACA however the answer appears to be NO, eligible veterans (as individuals) can opt VHA without a tax penalty.  However, family members must be enrolled in a government or private health insurance plan.  Why? The VA health care meets “minimum essential health care” under ACA rules even though it’s a benefit, not insurance per se. 

 In the video hearing below, Ch. Miller makes many important points.  Like the hearing participants, I’m left unenlightened however I recommend viewing it if you have the time.  For example, dual enrollment which many veterans now enjoy is a problem (but it’s not clear why).

April 24, 2013

USHR14 Committee on Veterans’ Affairs

Note:  The video does not begin until about the 40-minute mark timeline.  Click on video timeline until you find the beginning.

Topic: Implementation of the Affordable Care Act in VA

http://www.ustream.tv/recorded/31898351

My notes:

• VA:  The law has to be implemented before the actual effect on VA’s health care is known.
• About 9 million veterans are enrolled in VHA.
• Health choices:  About 66,000 new veterans are expected to enter the VHA and are included in the budget.   Some veterans will leave the VHA if they want to use the Premium Tax Credit to buy private insurance in the exchanges.
• Huh? “1 million in/1 million out?”  No one knows due to the various choices veterans will make in 2014.
• An estimated 1.3 million veterans are uninsured and but eligible to enroll in VHA.
• Females in households often make health insurance decisions.
• The miserly states (21 currently) that do not increase Medicaid are expected to effect veterans.  Stingy Florida and Texas veterans will be impacted.
• The Dept. of Treasury will allow veterans (and eligible civilians) to choose between market insurance or enroll in VA coverage.  Veterans can stay in VHA and uncovered family members must enroll in other types of insurance.
• Confusion reigns over the tax credit: VHA enrollees will not get the premium tax credit but family members in private care may/will (?) get the premium tax credit if income is 100%-400% of Federal Poverty Guidelines.
• Mr. Roe–Believes that many more than 66K new veterans will enroll (1:18).
• Dual enrollments–VA can currently bill private insurance.  If veterans drop private insurance, VA will be impacted moderately.
• Chairman Mr. Miller: “I’m lost” (re: premium tax credit) at 1:23.
• Will IT be in place between VA and IRS by Oct. 2013? Lots of wishful thinking expressed.
• VA says that ACA outreach/communications to veterans will roll out in May and June.  Hmmm–We haven’t seen any outreach in MN yet.
• (1:33) “That’s a problem.” Discussion: The tax credit is a percentage of family income and family size and based on Federal Poverty Line.  What happens to the credit when dependents has separate coverage from veteran.
• Will rural VA clinics be overwhelmed?
• Veterans will have to weigh the value of the tax credit versus the VHA services they receive.
• (2:00) One Congressman thinks the assumption to think that veterans will prefer over Medicaid over VA is “ridiculous”; he thinks that the 8 million of veterans with other insurance now should be considered and planned for.  (Medicaid is crappy in some states.)
• Service-connected veterans will have more incentive to enroll/stay enrolled in VHA because of no co-pays.  Priority 8 veterans will have to weigh expected co-pays versus exchange co-pays/deductibles.  Accessibility is also an issue.
• Mr. Miller:  VA’s reliance on public service announcements is outdated.
• Priority 8 vets (called category 8 like a hurricane by Ch. Miller)–say what?

Will there be a flood of new veteran patients into VHA?  How can anyone decide without understanding anything about tax credit, understanding what private insurance products will cost, or whether employer insurance will be dropped, when none of this information is available yet?

But one thing is clear, uninsured veterans should get enrolled to avoid a potential tax penalty.  Dependents should also enroll in a health plan. There are numerous exceptions to avoid the penalty but the IRS road is going to be bumpy for a while.

Final hearing thoughts from a astute Congressman, Mr. Roe (M.D.-TN):  “…we don’t fully understand what we’re talking about…”

HELP