VA Wants to Be First, Not Last, Option

We live in an era when families with an aged father or uncle who is losing his memory don’t know where to turn for help, and the cost of drugs for the elderly can cripple a family’s budget.

For all those troubles, the Veterans Administration health system can be a major source of help.

Most people have a hazy notion of the VA as hospitals where combat veterans recuperate from their wounds after war and clinics where impoverished veterans can get treatment.

But the VA has come a long way in transforming itself into a sophisticated modern health care system offering a generous package of benefits, including doctor and hospital care and prescription drugs.

The VA has gone through a major reorganization, taking excess hospital beds out of service, emphasizing outpatient care and intensifying its efforts to reach out to all 26 million veterans. And the VA can boast some of the best training, teaching and treatment programs for Alzheimer’s disease and other dementias that can strike older Americans.

“The VA always had a stigma that we don’t provide the best care,” said Nicholas Gutierrez, clinic support staff coordinator at the VA’s Greater Los Angeles health care system, located in West Los Angeles. He boasts that the hospital’s affiliation with UCLA Medical Center provides patients with access to some of the top geriatric specialists in the country. “We’re saying to veterans, come visit us and see the changes in care and customer services. Come back and check us out.”

There are various priority categories for treatment, starting with those who have health problems connected with their time in the service, and including the poor. The lowest-priority category includes those who don’t have any service-connected disabilities and make too much money to qualify for free care. In earlier times, more affluent and healthier patients might well have been turned away at many VA installations for lack of space and personnel to care for them.

But the VA changed its policy last year, and now promises universal access--or health care services for all those who have served in the armed forces. It is attempting to attract more healthy veterans who in the past have opted to see private doctors rather than a doctor at the VA.

“They have said, ‘We will provide health care if you come to us,’ ” said Phil Budahn, a spokesman for the American Legion. “We’ve seen the VA doing some very aggressive outreach to veterans who don’t have service-connected problems.”

A program called SHAPE (Screening Health Assessment and Preventive Education) sends VA doctors into local community meeting halls to provide blood tests and screenings for depression, memory changes and other problems.

As the population of veterans ages, the demand for geriatric services soars. The VA system, with its special expertise, can provide a full physical and mental examination to determine if someone has developed Alzheimer’s or another memory-destroying dementia.

The West Los Angeles center and other VA facilities in Seattle, Minneapolis, Rochester, N.Y., and Bedford, Mass., get particularly high marks from the Alzheimer’s Disease Assn. as places “we would be very comfortable encouraging people to go to,” said Steve McConnell, director of the association’s legislative policy office in Washington. “They have good people with considerable expertise.”

A day’s geriatric medical work-up at the VA, with access to multiple specialists, can cost as little as $45.80, the co-payment for a single visit. And for those whose income meets certain standards, the bill is zero.

The VA benefits package includes pharmaceuticals, with a modest $2 co-payment for each prescription. But the VA won’t fill prescriptions ordered by outside doctors. Someone who wants to take advantage of this benefit must enroll in the VA program and be examined by VA physicians.

Care is free for anyone who suffered a service-connected injury or disability.

For others, there is an income test, with a sliding scale. For example, care is free for a veteran with no dependents whose income is below $22,351 a year. A person with one dependent can have an income up to $26,824 annually. The scale climbs to $34,306 for someone with six dependents, and rises by $1,496 for each additional dependent.

When income rises above the eligibility standard for free care, the veteran will pay a $45.80 co-payment for a visit to the hospital, regardless of how many doctors he sees. For a hospital stay, there is an initial charge of $768 for the admission and a daily charge of $10.

The VA is inviting all veterans to enroll for care, whether or not they need to see a doctor now.

The toll-free number for eligibility information is (877) 222-VETS.

Local numbers include the Greater Los Angeles facility, (310) 268-3290; Long Beach and Orange County, (562) 494-5915; and San Bernardino and Riverside, (909) 777-3221.

Q. I suffer from a chronic disorder that can only be dealt with by frequent screenings (MRIs and CAT scans) and multiple surgeries. At present I am self-employed and on COBRA from my last employer. What, if any, are my options in establishing health insurance outside of my COBRA coverage, which will lapse in a few months? I fear that no insurance carrier will accept me given my continuing condition, and that it would be unaffordable if someone did accept me. If I am able to find a permanent job, would a new group insurer be able to reject my coverage?

A. You have a difficult situation, but some protections are available under federal law. If you do find a new job with a company that offers health insurance, your employer cannot discriminate against you because of existing health problems. As long as you haven’t had a break in coverage of more than 63 days, you can join the new employer’s health plan--at the same cost as anyone else at the firm. COBRA (the Consolidated Omnibus Budget Reconciliation Act) guarantees insurance after a worker leaves a job as long as premiums are paid.

When COBRA expires after 18 months (or 36 months for ex-spouses and dependents after a divorce), the next protection comes from the Health Insurance Portability and Accountability Act. This guarantees access to the insurance plan of a new employer. If you decide to stay self-employed, the law requires insurers to make individual health policies available to you. But the insurers are free to charge whatever rate they want. Try contacting a health insurance broker to get an idea of rates for individual policies. And begin shopping immediately, before your COBRA protection runs out.

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We welcome your suggestions, questions and tips about the fast-changing world of health care. Write to Bob Rosenblatt, Health, Los Angeles Times, Times Mirror Square, Los Angeles, CA 90053. Or send e-mail to bob.rosenblatt.latimes.com.