They deserve better
BY JANET PEARSON Associate Editor
Sunday, January 13, 2013
1/13/13 at 7:02 AM
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Among the tens of thousands of Oklahomans who could receive much-needed health care if elements of Obamacare were enacted in the state are about 50,000 veterans and their family members who have no health insurance and who also are facing such issues as chronic health problems, little education and unemployment.
Oklahoma, in fact, has one of the highest rates of uninsurance among younger veterans at an estimated 13.8 percent, according to a recent national study. Only four other states had higher rates. Oklahoma had the second highest rate of uninsurance for younger veterans' family members at 11.9 percent.
According to the study, about half of these uninsured veterans would qualify for coverage under the Medicaid expansion called for in Obamacare, and another 40 percent might qualify for subsidized coverage through health insurance exchanges envisioned by the law.
But of course, as most readers know, Gov. Mary Fallin has declined to go along with the Medicaid expansion called for in the Affordable Care Act. And she along with legislative leaders also have refused to set up the health-insurance exchanges that would help these Oklahomans and many others obtain subsidized coverage.
Ironically, the states that have made the least progress toward expanding Medicaid and implementing exchanges also had the highest rates of uninsurance among veterans. Ironic, perhaps, but not surprising.
So these men and women, and their family members, who all have sacrificed so much for the safety and well-being of their fellow Americans, will continue to do without the coverage many desperately need, and to suffer the consequences.
That's the thanks they get.
Doing without
In a report issued last May, "Uninsured Veterans and Family Members: Who Are They and Where Do They Live?", researchers for the Urban Institute exhaustively detailed the plight of the 1.3 million veterans ages 19-64 who have no insurance coverage. The report, funded by the Robert Wood Johnson Foundation, also looked into the problems faced by the 900,000 younger veterans who have only Department of Veterans Affairs health care, and the 900,000 family members of veterans who also have no health insurance.
The VA operates an impressive system of medical centers, clinics and other facilities and is internationally recognized for the care it provides. But for various reasons, many veterans do not or cannot use VA health care services. Eligibility is based on such factors as service-related disabilities and income level. VA facilities may simply be too far away from some veterans to be accessible.
Even those who do receive VA services could receive additional health-care services through the ACA offerings, according to the study.
Veterans in many cases don't have the benefit of employer-sponsored health insurance because they often are "less connected to the labor force," in part because of their military histories.
The lack of insurance coverage is exacting a serious and disturbing toll: The report noted, citing a 2010 study, that more than one in five veterans under the age of 65 reported being in fair or poor health.
The Urban Institute report was based on data culled from the 2010 American Community Survey conducted by the U.S. Census Bureau. It is described as the first to provide estimates of uninsurance of veterans ages 19 to 64, and their families, and to determine if the ACA could help reduce their uninsurance rates.
According to the study, one out of every 10 veterans in that age bracket lacks insurance. Altogether, there are 2.3 million uninsured younger veterans and family members.
More than 43 percent of these veterans served between 1990-2010, and almost half are under age 45.
They also were found to have low levels of education, higher levels of unemployment and lower rates of full-time work, and were less likely to be married than veterans with insurance.
So it's not surprising that nearly half of them - about 49 percent - might qualify for coverage through Medicaid expansion, and another 40 percent of them have incomes that would allow them to qualify for subsidized coverage through ACA-created exchanges.
But both of those elements of the ACA are initiatives that Oklahoma's leadership, and many Oklahomans, want nothing to do with.
The researchers also found that high numbers of veterans who receive VA care, who tend to be older, also have incomes low enough to qualify them for expanded Medicaid coverage, which would enable them to supplement their VA coverage.
They also concluded, not surprisingly, that significant numbers of family members also would qualify for coverage under the ACA; about 85 percent of them would qualify for either the Medicaid expansion or the subsidized exchange coverage.
Tragic toll
Researchers estimated there are 26,000 uninsured veterans ages 19-64 in Oklahoma, placing our uninsured rate for that population at 13.8 percent. Four other states - Louisiana, Oregon, Idaho and Montana - had higher rates, ranging between 14.1 percent and 17.3 percent.
The number of younger veterans' family members without insurance was estimated at 23,000, for an uninsured rate of 11.9 percent - the second highest in the country.
The researchers studied the activities of each state with regard to establishing exchanges and expanding Medicaid and found "higher uninsurance rates among veterans and their family members in states that have taken only limited steps toward implmenting exchanges under the ACA."
And what are the consequences of this inability to access needed health care? We've all seen the gut-wrenching news reports about the physical and mental suffering that plagues veterans. Here are the numbers behind them, from the Census Bureau's 2009-10 National Health Interview Survey: "Nationally, 41.2 percent of uninsured veterans reported unmet medical needs, 39.5 percent reported unmet dental needs, and 33.7 percent reported delaying care due to cost. ... 33 percent have at least one chronic health condition; 15.3 percent are in fair or poor health; 15.9 percent are limited because of physical, mental or emotional problems; and 40.1 percent reported experiencing negative feelings that interfered with their activities."
This is the thanks they get.
Janet Pearson 918-581-8328
janet.pearson@tulsaworld.com
Associated Images:
'Obamacare' could aid state veteransVeteran Curtis Randall at the Claremore veterans center in Claremore in 2009. JAMES GIBBARD/Tulsa World file
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