Rising Enrollment in VA System Creates Strains

The veterans health care system is struggling to accomodate an increasing number of eligible seniors who are enrolling because of its low prescription drug copayments, the New York Times reports. Since the mid-1990s, the number of veterans enrolled in the VA health system -- which includes 850 outpatient clinics, 163 hospitals and 137 nursing homes -- has doubled to six million. At the same time, the Department of Veterans Affairs' drug costs have increased more than 160%, from $1.1 billion in 1996 to $2.9 billion last year. Some aging veterans are entering the system because private doctors are refusing to see new Medicare patients and many Medicare managed care companies are either exiting markets or cutting back on benefits. The rising enrollment has created waiting lists to see a VA doctor that can reach years. For example, 4,429 veterans at Bay Pines VA Medical Center outside St. Petersburg, Fla., have to wait until October 2005 for their first doctor appointment.

Responding to the challenge of increased enrollment, the VA system has tried to trim its benefits packages to reduce costs. In November, VA Secretary Anthony Principi announced that he planned to suspend enrollment for "Category 7" veterans -- those who are not disabled or poor and do not have medical problems resulting from military service. At the last minute, however, the Bush administration provided the money for the coverage of these veterans in its fiscal year 2003 budget proposal. The administration's budget does call for Category 7 veterans to pay a $1,500 annual deductible -- the first ever sought by the system -- but "veterans' supporters on Capitol Hill have effectively killed that proposal, although Principi said that without it, there would be a $1.1 billion gap next year in the department's $25.5 billion medical budget," the Times reports. The VA did raise the drug copay for Category 7 veterans last year from $2 a prescription to $7, but that figure remains "well-below" the copayments seen in most private health plans. VA officials say the system's struggles will likely not subside until Congress creates a comprehensive Medicare drug benefit. "We are in somewhat of a crisis mode," Principi said, adding, "Until such time as our nation has a pharmacy benefit, there will be extraordinary pressures on us to provide those drugs" (Freudenheim, New York Times, 4/6).