War at home: Lack of health insurance killed 2,266 veterans last year

Last year, some 307 American soldiers died in Iraq -- nearly twice the number killed in Afghanistan. But the home front was far deadlier for veterans: an estimated 2,266 U.S. military veterans died last year -- not from combat but from lack of health insurance, Harvard Medical School researchers report. That's more than seven times the number of U.S. casualties in Iraq last year, or six preventable deaths a day.

Despite a common misconception that all veterans qualify for lifetime care through the Veterans Health Administration, researchers found that 1.46 million vets under 65 were uninsured last year. Some earn too much to qualify for Veterans Affairs assistance but too little to afford private insurance.
"They're less likely to get care for common conditions like diabetes, high blood pressure, and high cholesterol," says study co-author Steffie Woolhandler, a professor at Harvard Medical School. "These conditions are manageable if you get treated, but can turn lethal if you don't."

Woolhandler and co-author David Himmelstein, a Harvard associate professor of medicine, say the health reforms under consideration by Congress won't improve the vets' lot anytime soon; any reforms aren't expected to help uninsured Americans before 2013. And many veterans they studied are middle-income earners who wouldn't qualify for government subsidies to buy insurance -- so they would have to come up with "thousands and thousands of dollars out of their own prockets," Woolhandler says.

"The best thing that can be said about the proposed reform is that there is some Medicaid expansion," says Woolhandler. "But the type of working families that most veterans represent would get very little help out of these bills."

The veterans' bad news came Wednesday: Veterans Day, when the U.S. honors armed servicemembers past and present, on the 91st anniversary of the signing of the 1918 armistice ending World War I.

The researchers arrived at their estimate of 2,266 deaths last year through research finding that uninsured working-age Americans are 40% more likely to die than those with private coverage, and about 45,000 deaths in the U.S. each year are attributed to a lack of health insurance.

Colleen Corliss, a representative of veterans organization Swords to Plowshares, says the number is no surprise. Of those veterans who have recently left the military, 18% are unemployed, says Corliss, whose San Francisco–based organization provides health, legal, and social services to veterans. About 25% of employed vets earn less than $21,840 a year, Corliss says. "Veterans, statistically across the board, are in a lower income bracket," she says.

Woolhandler says that VA care is not as easy to get as the public thinks. "If you get your leg blown off, you'll get taken care of for the rest of your life," she says, citing the types of service-connected disabilities that qualify for coverage. But not all combat veterans automatically qualify for care, she says. Some receive care only after satisfying a means test, and anyone with income much above $40,000 a year may be ineligible, she says.

Corliss estimates that 35% of her organization's clients don't qualify for VA care; one reason is discharge status. "A lot of older Vietnam-era veterans didn't go through the paper trail and didn't get VA care," she says.

The veterans' predicament is not too different from that of many Americans who find themselves uninsured because they earn too much to qualify for government-subsidized care but too little to pay for private health insurance. But given the enormous sacrifices many veterans have made in serving their country, their plight seems all the more troubling.

"On this Veterans Day," Himmelstein says, "we should not only honor the nearly 500 soldiers who have died this year in Iraq and Afghanistan, but also the more than 2,200 veterans who were killed by our broken health insurance system."
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