摘要：Objectives. Veterans Administration health care enrollment is restricted to veterans with service-connected problems and those who are poor. We sought to determine how many veterans were uninsured, trends in veterans’ coverage, and whether uninsured veterans lacked access to medical care. Methods. We analyzed annual data from 2 federal surveys, the Current Population Survey for the years 1988 to 2005 and the National Health Interview Survey for 2002 to 2004. Results. Nearly 1.8 million veterans were uninsured and not receiving Veterans Administration care in 2004. The proportion of working-age veterans lacking coverage peaked in 1993 at 14.2%, fell to 9.9% in 2000, and rose steadily to 12.7% in 2004. Uninsured veterans had substantial access problems; 51.4% had no usual source of care (vs 8.9% of insured veterans), and 26.5% reported failing to get needed care because of the cost (vs 4.3% of insured veterans). Conclusions. Many US veterans are uninsured and lack adequate access to health care. Expanded funding for veterans’ care is urgently needed; only national health insurance could guarantee coverage to both veterans and their family members. As clinicians at an urban public hospital, we often care for uninsured patients. Recently, we noted that several patients without coverage were combat veterans. We were surprised. We, and most colleagues with whom we conferred, assumed that all veterans qualify for care at Veterans Health Administration (VA) hospitals and clinics. In fact, only a minority of veterans—those disabled by military service—are automatically eligible for VA care. The Veterans Eligibility Reform Act of 1996 opened VA enrollment to all veterans, although non-poor veterans were required to make co-payments of up to $50 per day for outpatient care. (Poor is defined by assets and an income threshold that varies with location and family size. In general, veterans earning more than $30 000 per year are not eligible for free care.) However, a July 18, 2002, memo from the deputy undersecretary for health for operations and management ordered VA regional directors to “ensure that no marketing activities to enroll new veterans occur,” citing “demand for healthcare that exceeds our resources” and “very conservative OMB [Office of Management and Budget] budget guidelines.” 1 Subsequently, the secretary of veterans affairs ordered a halt to the enrollment of most nonpoor veterans as of January 17, 2003. 2 We found scant data on uninsured veterans. Several studies identified the safety net function of VA care, 3 , 4 looked at uninsured veterans in a single state, 5 or offered limited data for a single year. 6 An Internet posting by VA analysts offered some data on the number of uninsured veterans. 7 Our encounters with uninsured veterans led us to explore 3 questions: are many veterans uninsured? Do uninsured veterans suffer problems in access to care similar to others who are uninsured? Is this a new problem?
