Nineteen states are holding out against expanding Medicaid, many Republican-controlled — but their tough position could cost more than 600,000 veterans' health coverage.

NBC News reports that an Urban Institute study found that 604,000 veterans are in the so-called “Medicaid gap” — they make too much money to get federal subsidies to buy health coverage on the Affordable Care Act exchanges, but they’re not poor enough to qualify for Medicaid, either.

In addition, researchers said that those veterans don’t all get or qualify for care from the Department of Veterans Affairs — which leaves them out in the cold.

The report says in part, “Some uninsured veterans may qualify for VA [Veterans Administration] care, but not all take up the available coverage or meet the eligibility requirements, which are based on service-connected disability status, veteran discharge status, income and other factors.”

While it’s an improvement over 2014, when 700,000 veterans were shut out of healthcare coverage, it’s by no means something to be proud of. And even in states that have expanded Medicaid, lots of veterans will be in that gap — although states that restrict who can and can’t qualify for Medicaid will be shutting out many more veterans.

The report says, “If Medicaid expansion decisions do not change between now and 2017, we project that approximately 604,000 veterans will be uninsured in 2017 and that 54 percent will be living in states that have yet to expand Medicaid.”

While the ACA has benefited plenty of formerly uninsured Americans — the most recent Census Bureau data indicate that the percentage of uninsured has fallen from 16 percent in 2010 to 9.1 percent last year, and the Health and Human Services Department estimated that 20 million Americans became insured between 2010 and 2016 — veterans have seen gains, too.

“Between 2013 and 2015, the uninsured rate for nonelderly veterans fell by an estimated 42 percent, declining from 11.9 percent in 2013 to 8.5 percent in 2014, and falling further to 6.8 percent in 2015, according to the National Health Interview Survey,” the Urban Institute study says, continuing, “Over this time, veterans also experienced fewer unmet health needs, suggesting that increased coverage translated into improved access to care.”

But that doesn’t help the 600,000+ who won’t be covered in the states that won’t expand Medicaid. Many people believe that all veterans are entitled to receive medical care through the VA, but that’s not the case — and without Medicaid expansion, they’ll be out of luck.

Instant Insights /

States could lock 600,000 vets out of health coverage

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