About 1.3 million U.S. veterans and their spouses—including more than 200,000 in Texas—are uninsured and nearly 40 percent would qualify for Medicaid if it were expanded under the Affordable Care Act (ACA), according to an Urban Institute analysis.
Texas has the highest number of uninsured veterans and spouses of any U.S. state. Texas has chosen not to participate in Medicaid expansion under the health reform law.
Nearly 49,000 veterans are at or below 138 percent of the federal poverty level (FPL), which is the Medicaid qualification income under the ACA. About 12,000 of those are between 100 and 138 percent of FPL, which means they will qualify for subsidized insurance on the health insurance exchanges in 2014. Those below the FPL are ineligible for insurance subsidies and most will not qualify under the existing Medicaid guidelines—which is an annual income of less than $5900 for a working adult with dependent children and a family of four, or half that amount if jobless.
Another 17,600 spouses of veterans are at or below 138 percent of FPL, of which 11,500 are considered poor.
Veterans are eligible for health care through the Department of Veterans Affairs. However, many do not have access to VA facilities or are unaware they are eligible for care. The VA also gives care first to military retirees and those with service-related medical conditions. Only about 1 out of 3 veterans are enrolled in VA coverage nationally. VA care is not an option for family members of veterans.
About 1 out of 3 uninsured veterans have at least one chronic condition, and about the same proportion have delayed seeking healthcare because of cost.
Texas is one of 15 states that have declared they will not to participate in Medicaid expansion. Seven states—California, Texas, Florida, Georgia, Michigan, North Carolina and Ohio—are home to more than 43 percent of poor veterans. Of those, Texas, North Carolina and Georgia do not plan to expand Medicaid.
Nineteen bills supporting Medicaid expansion have been filed during the current legislative session.
Steve Jacob is editor of D Healthcare Daily and author of the book Health Care in 2020: Where Uncertain Reform, Bad Habits, Too Few Doctors and Skyrocketing Costs Are Taking Us. He can be reached at [email protected].
