Veteran, Portageville native, champions change

COLUMBIA -- Ryan Gill has big plans.

In the long-term, the University of Missouri senior hopes to enter law school, and when finished, work representing veterans. In the short-term, Gill hopes to persuade state lawmakers to do something for veterans and their families that they won't do for the public at large -- expand Medicaid eligibility.

The main groups who benefit from a bill proposed by Sen. Ryan Silvery, R-Kansas City, Gill said, are students and veterans struggling to find their place after life in the military. Department of Veteran Affairs benefits are good for the veterans able to us them, he said, but don't cover dependents and suffer from bureaucratic inertia.

"If we don't cover these individuals while they are young, or the ones that have fallen down to get them back on their feet, what a squandered opportunity we have lost to contribute something to our economy, especially the young veterans," said Gill, president of the Mizzou Student Veterans Association and board member of Welcome Home Inc., a homeless shelter for veterans.

Gill is a native of Portageville in southeast Missouri and a six-year veteran of the Missouri National Guard. Recently Gill was in Jefferson City with former U.S. Kit Bond and other student veterans to organize support for Silvey's bill with the Missouri Association of Veterans Organizations.

Bond also lobbies lawmakers for a general expansion of Medicaid eligibility under the 2010 Affordable Care Act on behalf of the Missouri Chamber of Commerce. The Republican-dominated legislature has resisted all overtures from Democratic Gov. Jay Nixon and business groups like the Chamber to expand eligibility for Medicaid under the 2010 federal law also known as Obamacare. The political battle over the federal law has dominated debate, with some Republicans such as Silvey futilely proposing plans to overhaul the program and expand coverage as a compromise.

The expansion plan for veterans -- which mirrors the eligibility limits of the ACA -- is not designed primarily to undercut opposition to general expansion, Bond said. "I am convinced it would be a good program and where it goes from there we can't say."

The 2010 law provides federal funding through 2017 to expand coverage to 138 percent of the federal poverty guideline, $16,104 this year for a single person and $32,913 for a family of four. After 2017, the state pays a small share, capped at 10 percent after 2023.

Missouri pays about 39 percent of the $8.5 billion cost of the current Medicaid program for about 870,000 people. Adults who do not qualify based on age or disability are not eligible for coverage unless they have children. The income limit for those who have children is about 18 percent of the poverty guideline.

Full expansion would add about 300,000 people. Silvey estimates his bill would add as many as 22,000 to the rolls. The state would pay its current share for their coverage.

The issue for veterans and their families arose last year after he was stymied on a general Medicaid plan, Silvey said. "So my thought was if I can't solve the whole problem, maybe I can solve a piece of the problem," he said.

Sen. Kurt Schaefer, R-Columbia, is an opponent of Medicaid expansion. He said he is skeptical of Silvey's proposal and believes it could create a gap in coverage that the courts would not accept.

"I think there is a high probability of a lawsuit filed and a court basically interprets that to mean that the state of Missouri passed a statute to increase it up to 138 percent, and because under Title IX it is an entitlement, they don't get to pick and choose who gets it."

Debate on Silvey's bill should look at the long-term benefits, not the politics of Obamacare, Gill said. He sees his own future in jeopardy if he suffers a costly accident or unforeseen illness before finishing school.

He will graduate with an agriculture degree in May and, if all goes as planned, enter law school in the fall. His five years of VA coverage based on deployments will end by his third year of law school.

"I am going to be 30 years old when I am an attorney," Gill said. "I feel I am so far behind the 8-ball as it is because of my service. If something happened that I had to drop out of even undergrad to get a job to pay my medical bills, I don't know that I would come back."

Low-income veterans are eligible for VA coverage beyond the post-deployment period, said Stephen Gaither, spokesman for Truman Memorial Veterans' Hospital. The VA has eight priority groups for care, with income eligibility ranked fifth. Veterans eligible for Medicaid are automatically included in the fifth priority group.

Gill said he has no complaints about his VA coverage. Veterans with limited means for traveling can have difficulty using the VA, he said. Veterans can also have special health issues and a greater need for mental health and substance abuse treatment.

"We still have 22 veterans a day committing suicide," he said. "The active duty force is 1 percent of the population and ... an estimated one-third of all homeless people are veterans, the biggest portion of them combat veterans."

Veterans generally must go to a VA facility to receive treatment, Gaither said. Last year, Congress included an exception for patients who must travel more than 40 miles or wait longer than 30 days for an appointment. That provided options, Gaither said, but only for veterans and not for their families.

"That is the most important part of that legislation," he said. "VA health care benefits are for veterans and not VA health care beneficiaries' dependents."