This article appeared in the March 26th, 2009 issue of the Louisville "Courier-Journal"

Phyllis Kruer served in the Navy and has a simple philosophy about veterans' health care: "If someone's gonna risk their life, they should be taken care of."

So she opposes a 6-year-old rule that bars most middle-class veterans who weren't injured in the military from enrolling, as she has, in the U.S. Department of Veterans Affairs medical system. And she supports plans to start rolling back that policy by re-opening enrollment to an additional 265,000 veterans.

"If you're a veteran, you should be entitled to all the care you need, regardless of income," said Kruer, a 54-year-old Borden, Ind., resident who served from 1986 to 1991 and gets care at the Louisville VA Medical Center off Zorn Avenue.

Veterans "donated time away from their families, away from their jobs, to serve their country," she said.

Under VA rules slated to take effect by July, single veterans in the Louisville area could enroll if they earn as much as $36,575 a year, and veterans with one dependent could enroll if they earn as much as $41,800. Under the old policy, the limits were $33,250 for a single veteran and $38,000 for a veteran with one dependent.

"We're pleased to be able to offer what has been called 'the best care anywhere' to many more veterans," VA Secretary James B. Peake said.

Jack Humphries, business office manager at Louisville's VA hospital, which serves about 165,000 veterans in Kentucky and Southern Indiana, said he's not sure how many area veterans will be able to sign up under the new policy.

Humphries noted that the VA is reaching out to local veterans' groups to let them know about the change -- which doesn't affect veterans already enrolled, or those returning from Iraq or Afghanistan, who can enroll within five years no matter what their income.

VA officials say the change is part of a gradual lessening of restrictions on middle-income veterans. President Barack Obama's fiscal 2010 spending proposal increases the VA budget from $97.7 billion to $112.8 billion, and highlights the administration's intention to expand eligibility to more than half a million veterans by 2013. Nearly 7.9 million veterans were enrolled in the VA health-care system nationally as of last October.

Several veterans' advocates said the change comes at a good time, with more of the 905,000 veterans in Kentucky and Indiana losing jobs and health insurance and turning to the VA for care.

"We do appreciate the fact that the VA is trying to open up health care to more veterans," said David Worley, executive director of the Kentucky Department of Veterans Affairs. "We would have liked them to go back to before 2003, when people were eligible regardless of income, but maybe this is the first step toward getting back to that."

Priority groups

When the VA imposed the enrollment restrictions, officials blamed budget constraints. They said non-disabled, higher-income veterans were driving much of the rapid growth in health-care enrollment between 1996 and 2003, hindering the system's ability to care for the disabled and poor.

Under VA policy, veterans fall into one of eight priority groups. The highest-priority veterans are those with service-connected disabilities considered to be 50 percent or more disabling, and those determined to be unemployable because of service-connected conditions.

Those shut out from care fell into the lowest-priority -- Priority Group 8, which includes veterans without service-connected injuries or illnesses and with incomes above the cutoff, which varies by area. In the first three years of the rule, a quarter-million Priority Group 8 veterans who sought care at the nation's VA hospitals were turned away.

And that wasn't the only way the VA tried to limit enrollment. In 2002, the VA issued a national memo that discouraged recruiting veterans for enrollment. A similar directive issued in 2004 for the VA MidSouth Healthcare Network, which includes the Louisville medical center, said "facilities may not aggressively take steps to recruit new enrollees or new workload."

Cletus McCauley, a 58-year-old Army veteran who served in the early 1970s, said he has health insurance as a retired General Electric worker, but thought about turning to the VA to get medicine for a knee problem.

Worley said many veterans like McCauley turn to the VA for prescription medication because it's comparatively inexpensive there.

But knowing about the income limits discouraged him from enrolling.

"I thought I wouldn't qualify," he said -- though with about $30,000 in retirement income, he most likely would.

$375 million in budget

To support the new enrollment, Congress provided $375 million in the VA's fiscal 2009 budget -- funds some local lawmakers said they were happy to support.

"I believe that our veterans deserve the best care possible …, " said Sen. Mitch McConnell, R-Kentucky. "Last year, I supported and Congress directed the VA to increase enrollment of our Priority 8 veterans, and I am glad to see that the VA is now implementing this provision."

Katie Moreau, communications director for Indiana Democratic Rep. Baron Hill, said he supported the appropriations act that included the money. Moreau said the VA enrollment change "is great news for veterans, particularly during this time of economic downturn. Certainly, having access to good health (care) is crucial."

Kentucky Rep. John Yarmuth, D-3rd District, said he supported the change in Congress as well, and expects it to have a big impact in Kentucky, where a higher-than-usual number of veterans are expected to qualify under new rules because the median household income of about $40,000 a year is about $9,000 below the national average.

But, he added: "We still have a long way to go. I'd love to see the eligibility expanded to bring far more middle-income veterans into the program. We underfunded veterans' health care for a long time, and there's a lot of catch-up that needs to be done."

Several veterans said the changes are a good start, but they would really like to see the restrictions lifted completely -- something Yarmuth said probably won't happen soon given the economic recession.

Army veteran Russell Brooks, a 68-year-old Louisville man enrolled in VA health care, said all who have served their country deserve the same privilege he enjoys.

"If you're a veteran, you should be able to use the VA facilities," he said. "I don't believe your income should be involved -- period."

Reporter Laura Ungar can be reached at (502) 582-7190.