The crisis over wait times and access to care within the Department of Veterans Affairs health system has raised questions about whether similar problems could occur in the broader health care system as government-subsidized coverage spreads throughout the country.
Though millions of uninsured Americans will get more care than they do now, policy experts say coverage isn’t the same as access, and lower-income Americans may experience barriers in some markets.
VA health care is limited by an annual budget, unlike the coverage provided by the health care law. As more people enroll, either through an expansion of Medicaid or through private plans whose cost is subsidized, doctors and hospitals will get more paying customers.
In general, they’ll respond to this growth in demand by increasing the supply of their services, which will help keep waiting times from ballooning.
“If the insurance payments are there, somebody’s going to show up to take them,” predicts Timothy Jost, a law school professor who serves as a consumer advocate on a panel that advises the National Association of Insurance Commissioners about the health care overhaul law.
The bureaucracy running the VA hasn’t been able to match its supply of clinical services to growing demand by veterans for care, either because it is underfunded in the annual appropriations process, because the VA has squandered resources, or both.
Analysts differ over which factor is to blame, but they agree that the automatic increase in spending under entitlement programs helps fuel supply and makes it easier to keep up with growing demand.
“There is a huge difference between the VA and the system that is being established under the Affordable Care Act,” Jost says. “The VA is a budget-limited service.
“If you look worldwide, what you see is that in countries where you have budget-limited national health services, you’re much more likely to see services rationed by wait times than countries where you have social insurance or private systems where you’re likely to have higher costs but less in the way of wait times,” he adds.
Joseph Antos, a health policy expert at the American Enterprise Institute, says, “Clearly if you’re working on a budget you’re going to have a problem” matching supply and demand.
Paul Ginsburg, a health care financing expert who is a professor at the University of Southern California, underscores that the difference is between the “government provision” of care in the case of the VA and “government financing” of care under Obamacare.
Community health centers can expand when demand increases under the health law because more dollars come into the privately run centers as more people come in for care, he says.
But with the supply of providers not likely to change much soon and the number of people getting coverage expected to grow much more quickly — the Congressional Budget Office estimates the 8 million people getting coverage on exchanges this year will increase to 22 million in 2016 — isn’t some increase in waiting times inevitable?
Vice President Joe Biden waits to conduct a mock swearing-in ceremony with Sen. Brian Schatz, D-Hawaii, in the Capitol's Old Senate Chamber, December 2, 2014. Schatz was sworn in to serve the remainder of his term since he was appointed to the seat after Sen. Daniel Inouye, D-Hawaii, passed away.