Former VA Official: Obamacare Puts Vets at Risk


The Affordable Care Act -- generally known as “Obamacare” -- could lead to increased health complications, emergency room visits and even shorter life spans for some veterans, according to a former under secretary of Health for the Department of Veterans Affairs.

Dr. Kenneth Kizer, director of the new Institute for Population Health Improvement at the University of California, Davis, Health System, said the ACA’s creation of more healthcare options could cause increased “fragmentation” of care among vets who now rely solely on the Department of Veterans Affairs.

“Some data suggest that veterans receiving care from both VA and non-VA sources are more likely to be re-hospitalized and to die within a year compared with VA-only users,” Kizer wrote last year in a commentary for the Journal of the American Medical Association.

Kizer said his commentary, drawn from a longer paper he wrote on the effects of the ACA on veterans’ healthcare, is not a criticism of the new law.

“I’m a firm supporter of the Affordable Care Act,” he told in a telephone interview on Wednesday. “The issue is that in anything as complex as the [ACA], or in healthcare, there is going to be unintended consequences. Some are going to be good and some may not be.”

In April, Rep. Jeff Miller, R-Fla., chairman of the House Veterans Affairs Committee, quoted from Kizer’s commentary, noting that “the overall net effect of the ACA on health care for veterans is uncertain at this time, although it will likely have a number of intended positive and unintended negative effects.”

Miller took testimony that day from Dr. Robert A. Petzel, the current undersecretary for Health at VA, who told the House panel that the VA has been working to understand the impact of the ACA on veterans.

The VA would not comment for this story except to reiterate Petzel’s testimony.

Fragmented healthcare among vets is not solely a function of the advent of the ACA. VA-enrolled veterans already may have additional private healthcare plans that enable them to get medical care from more than one source.

However, the ACA is expected to create new low-cost options through the private sector and the expansion of state’s Medicaid programs. Officials believe this will likely lead to more vets using the VA to pick up a separate provider. For some vets, it may be a matter of convenience or timeliness with a private plan enabling them to get some medical services closer to home or more quickly.

The VA anticipates that after some vets leave the VA system for other providers, others currently not enrolled will join. VA officials expect a net gain of 66,000 new VA enrollees.

Fragmented care occurs when medical providers do not have access to a patient’s complete medical history. The result is a diminished continuity and coordination of care “resulting in more emergency department use, hospitalization, diagnosis intervention and adverse [health] events,” Kizer wrote.

For those reasons, Kizer recommended that the VA evaluate the effects of multiple health plans on veterans’ healthcare and develop plans to ensure that VA and non-VA healthcare is coordinated. So far, he has seen no indication this has been done. He considers it as important as the ongoing VA-Defense Department effort to create a seamless transition of healthcare for active duty troops going into the VA system.

Kizer cited in his writing a 2007 mortality study of vets who were stroke victims and used multiple health providers. He also cited a 1997 VA study that looked at veterans with heart conditions who used VA healthcare or private providers through Medicare.

Kizer made clear there have been no studies to try and fully explain the disproportionate mortality rates between the two groups of veterans. He said “numerous studies” have shown that veterans in VA healthcare are much more likely to receive evidence-based treatment and recommended services for prevention as well as early diagnosis of cancer, cardiovascular disease, diabetes and infectious diseases than people who get care from non-VA doctors.

Veteran patients -- including a significant number of individuals with chronic medical conditions or behavioral health diagnoses -- are especially vulnerable to problems arising from poorly coordinated healthcare, he said. As one example, he referenced in his commentary a Pennsylvania rural veterans health program whose private practice doctors lacked knowledge of mental health problems prevalent among vets, to include post-traumatic stress disorder.

“One reason I wrote [the commentary] is that I had been speaking about this at numerous VA forums, saying you need to look at this, you need to focus on this,” he said on Wednesday. “These are manageable issues, but you can’t do it in a week … I support the [ACA], but that doesn’t change the fact that it causes some wrinkles that need to be worked through.”

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