Medicaid expansion would increase vets' health options

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By MICHAEL GERSTEIN
Capital News Service
LANSING — While the Legislature wrestles with a recent House decision not to expand state health care for poor families through the Medicaid program, experts say roughly 20,000 veterans will also be left uninsured if the decision sticks.
“They’re going to be left out in the cold,” said Jan Hudson, a health care policy analyst for the Michigan League for Public Policy, which does research and advocacy regarding social issues like poverty, education and health.
The House recently rejected Gov. Rick Snyder’s proposal to expand Medicaid coverage despite available federal funding for the program.

According to the league, veterans in rural areas would benefit the most from the expansion because they would be able to use local hospitals in addition to sometimes-distant VA clinics.
The league says there are 19 rural counties with federal community-based health clinics for veterans, yet there are 57 rural counties with veterans.
Most of those communities are within 30 to 40 miles of a veteran health facility, according to the Michigan Department of Veterans and Military Affairs. But Hudson said even that’s an impossible distance for veterans who are sick or without transportation.
“If there’s a facility that’s 30 miles away, that’s a real problem,” she said.
There are also five VA medical centers in Ann Arbor, Battle Creek, Detroit, Iron Mountain and Saginaw. The Iron Mountain facility has the largest geographic coverage area, acting as the only VA medical center in the Upper Peninsula, though there are five smaller outpatient clinics in the U.P. and one in Wisconsin.
A Medicaid expansion would allow veterans to receive care at local hospitals, cutting down necessary travel distance.
But specialists are rare in remote areas of the state – not just for veterans, but for residents in general – a point acknowledged by Department of Community Health.
“There are shortage problems,” said the department’s public information officer, Angela Minicuci. “They have to drive a long distance to get to specialists.”
Still, the department says there are more VA health clinics than ever before. And new measures have been taken to offer treatment.
Someone who’s seen those measures firsthand is Patrick Kline, an American Legion field officer.
He files medical claims for veterans, ping-ponging from Bay City to Alpena, and St. Clair to Mackinac, then to the Upper Peninsula every week.
Kline says that while VA hospitals were “terrible” in the past, they’ve improved dramatically. And subsequent travel times have dropped as more clinics opened.
“To be honest with you, I don’t like going to a private hospital anymore because you get treated so much better” at a veterans clinic, Kline said.
Reaffirming that point is Patrick Lafferty, the chief administrative officer for the Michigan American Legion. He said there’s been a “180-degree turnaround” in medical availability since the 1980s, when the only veterans clinic in the U.P. was the Iron Mountain facility.
With VA clinics now in smaller outside cities like Grayling, Cadillac and Mackinaw City, many vets are racking up fewer odometer miles to get care. And when they need a specialist, they can go into the local clinic and use Telehealth Care.
That’s basically a long-distance checkup via the Internet. And 25 percent of patients at the Iron Mountain-based Oscar G. Johnson VA Medical Center used it in 2012.
Far-away specialists can inspect rashes or infections, injuries or old war wounds, both physical and psychological. And the Iron Mountain center was one of the first in the nation to start using the online system in 1996.
A major problem is that veterans from, say, Sault Ste. Marie still might have to travel nearly 400 miles to Milwaukee, Wisc., to see a specialist, said Brad Nelson, public information officer for Oscar G. Johnson.
The clinic in Sault Ste. Marie – an Oscar G. Johnson outpatient clinic – doesn’t offer many of the same services as the Milwaukee VA Medical Center, Nelson said. He said that’s simply the nature of outpatient facilities.
But Nelson said, “We are really working hard to provide the best care possible to our veterans in a rural setting.”
To cope with distance and lack of transportation for some, Disabled American Veterans (DAV) – a nonprofit group – offers volunteer-operated vans to transport patients to veteran facilities.
In 2012, it trucked 297,848 miles, making stops in Sault Ste. Marie, Marquette, Houghton, Ironwood and Ontonagon multiple times every week. The VA also operates two 16-passenger buses, which run three routes, traveling up to 100 miles from Iron Mountain.
But he said the DAV vans can’t take wheelchairs or oxygen tanks.
Nelson said he didn’t know how many veterans were unable to travel to medical centers.
Overall, some 500,000 more Michigan residents would receive health care if the Legislature agrees to accept federal money for a Medicaid increase. That includes 21,500 new veterans and 10,300 of their relatives, who aren’t covered by VA health care.
Ari Adler, Republican press secretary for the House, said GOP lawmakers are concerned because full federal funding for the program will last for three years, after which the federal government would cover 90 percent of the expansion. He said it’s difficult to pull people off Medicaid.
Kurt Weiss from the governor’s communications office said Snyder still stands by his proposal for Medicaid expansion.
It’s currently stalled in the House Appropriations Subcommittee on Human Services.
Online sources for CNS editors:
http://www.ironmountain.va.gov/documents/2012OGJVAMCAnnualReport.pdf
http://michigan.gov/documents/dhs/2013_02_GreenBook_414158_7.pdf
http://www.rwjf.org/en/research-publications/find-rwjf-research/2012/05/uninsured-veterans-and-family-members.html
http://www.rwjf.org/en/research-publications/find-rwjf-research/2013/03/uninsured-veterans-and-family-members.html?cid=xem_veteransA&cid=

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