WASHINGTON — The Department of Veterans Affairs would waive copays for Native American veterans at VA hospitals and clinics under a new rule the agency proposed Wednesday, fulfilling a bipartisan mandate Congress enacted more than two years earlier.
Under the proposed rule, which would take effect sometime in the coming months after a 30-day public comment period that starts Wednesday, veterans who can prove their tribal affiliation would also be reimbursed for any copayments made since Jan. 5, 2022. Enrolled members of federally recognized tribes are already exempt from copays at Indian Health Service clinics, but until now that waiver had not applied to VA health care.
“It’s no mystery to a lot of people that health care is sometimes hard to come by in many Native American communities,” Travis Trueblood, director of the VA’s Office of Tribal Health, told reporters Tuesday. “So this effort by VA will enhance getting people into the facilities, helping them feel welcome and getting them to use those benefits that they’ve earned.”
Congress passed the measure as part of a package of veterans legislation at the end of 2020, and then-President Donald Trump signed it into law in January 2021. Trueblood said the nature of the federal rulemaking process makes it hard to say exactly when the change will take effect, but he emphasized that no veteran will be turned away from VA care for not making a copayment, even before the rule is finalized.
The VA already waives copays for some veterans based on their incomes, disability ratings and other factors, but others must pay $30 per visit.
“American Indian and Alaska Native Veterans have played a vital role in the defense of the United States as members of the Armed Forces for more than 200 years,” VA Secretary Denis McDonough said in a statement. “This rule makes health care more accessible and allows us to better deliver to these Veterans the care and health benefits that they have earned through their courageous service.”
The department said in a news release the new policy is intended to encourage veterans to seek regular primary care treatment, which can improve health in the long run, noting that copays would still apply if a veteran has more than three visits to an urgent care clinic in a single year.
The nonpartisan Congressional Budget Office estimated in 2020 the new policy would save Native veterans an average of $330 a year and would cost a total of $62 million from 2022 to 2025, with most of that projected cost based on extra health care services Indigenous veterans are expected to use due to the copay waiver.
The VA estimates there are at least 150,000 Native American and Alaska Native veterans living in the United States, but Stephanie Birdwell, director of the department’s Office of Tribal Government Relations, said the exact number is unclear. The Indian Health Service, a separate federal agency, estimates about 21,000 Native veterans receive health care from the VA each year.
Sen. Jon Tester, a Montana Democrat who chairs the Senate VA Committee, introduced the legislation in 2020 with his Republican counterpart, Sen. Jerry Moran of Kansas. Their bill directed the VA to enact the new policy in January 2022, which is why the proposed rule is retroactive to that time.
“I’m disappointed VA hasn’t implemented the law we passed two years ago to end copays for VA health care for Native veterans,” Tester told a VA official in a Nov. 30 hearing. “This creates a disincentive for Native veterans to use VA health care facilities, which is the opposite of what should be occurring.”
McDonough told reporters in a Dec. 1 news conference he was committed to getting the rule done, but he noted the federal rulemaking process required him not to comment on it.