VA Recoveries From Private Health Insurance and Proposed Means Test To Determine Eligibility for VA Health Care

GAO discussed two reports relating to the Veterans Administration's (VA) provision of health care to veterans with non-service-connected medical conditions and disabilities. In the first report, GAO recommended the passage of legislation authorizing VA to recover the costs of care provided to privately insured veterans with such conditions. GAO believes that VA could have recovered between $98 million and $284 million from health insurance companies for the instances of care it studied and that actual recoveries could be higher if Congress passes authorizing legislation. Under such legislation: (1) VA administrative costs should amount to less than 2 percent of total recoveries; (2) insurance companies' administrative costs should amount to less than 6 percent of total recoveries; (3) increases in insurance premiums would be slight; and (4) the insurance industry would be adequately protected. The second report that GAO discussed pertained to the establishment of different eligibility criteria that would include a test to determine veterans' ability to pay for non-service-connected conditions. GAO found 44,000 instances where VA provided health care to veterans who could probably have afforded to pay for their care. These instances cost VA about $163 million, of which the patients probably could have absorbed about $116 million. GAO noted that the second report was informational and was not intended to suggest alternatives to the proposed eligibility criteria.